Name______________________________________________
Address ______________________________________________________
City-State-Zip _________________________________________________
Home Phone __________________ Work Phone ____________________
E-mail Address ______________________________
Occupation ________________________________________
Initial annual dues are:
Individuals: $40
Couples: $50
Renewal annual dues are:
Individuals: $30
Couples: $40
Renewal dues should be paid by January 1. Anyone paying later than February 28 will not be included in the Roster.