Membership Enrollment Form

YES, please enroll me as a member in the category indicated:

Sponsor

Gold $1,000 or more    

Silver $500                                                                         

Grey $250

Annual Membership

Cooperate $500

Individual $35

Dual Membership $50

Student $5

Senior $15  (65 and up)                                  

Supporting Member: $100                                        

Member Name

Mr._______________________________                                   

Mrs.______________________________

Ms.______________________________

Address___________________________

City______________ State____ Zip_____

Email_____________________________

Please send gift renewal notice to:                

Name:____________________________          

Address:__________________________

City______________ State____ Zip_____

Special Notice: Do you work for or have you retired from a matching gift company” If so, contact your personnel office and possibly double your gift to the Society with matching funds.