_____$20 Individual ______$25 Family Membership Type: New ____ Renewal ____ Date ___________________________________
Name to appear on membership card _______________________________________
Other members ___________________________________________
Street ___________________________________________________
City _________________________State______Zip_______________
Phone ____________________ Cell ________________________
Fax _______________ E-mail _____________________________
Include my name, address and phone number in membership list to be handed out to all club members: Yes _______ No ______
Send me the newsletter by mail__________ by email_________________________
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