Membership Application

NEW MEMBERSHIP_____ RENEWAL_____

NAME:_________________________________ ALIAS*:________________

STREET:______________________________________________________

CITY: ____________________________STATE:_____ ZIP:______________

PHONE:______________________ CELL PHONE:______________________

EMAIL:_______________________________________________________

Please select the membership desired:

_____Life Membership ($500 - ask us about payment plans)

_____Individual Membership ($35.00 a year + $13.00 for outside USA)

_____Family Membership ($35.00 a year + $10.00 for each
additional family member listed + $13.00 for outside USA,or Life Membership plus
$10.00 a year for each additional family member listed + $13.00 for outside USA.)

Please List Additional Family Members:

____________________ ____________________

____________________ ____________________

_____ Senior Citizen (65)/Full-Time Student/Fixed Income ($30.00 a year + $13 for
outside USA)

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