Name: ___________________________________________

Address: _________________________________________

City: ____________________________________________

State: ___________________________________________

Zip: _____________________________________________

Phone: ___________________________________________

E-mail: ___________________________________________

Type of Membership:

_____ Individual Yearly ($15.00)

_____ Family Yearly ($25.00)

_____ Individual Lifetime ($500.00)

_____ Corporate Yearly ($500.00)

Enclosed is a check or money order for $_____._______ for my membership.
(Never send cash by mail.)