*First Name: | |
| *Last Name: | |
| *Mailing Name: | |
| *Address: | |
| *City: | *State: *Zip: |
| *Phone: | |
| *e-mail: | |
| Number of Children: | Schools Children Attend: |
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*Type of Membership: | |
| Single | $5 for a year $10 for 2 Years |
| Family | $10 for a year $20 for 2 Years |
| Student | $2 for a year $4 for 2 Years |
| Corporate | $25 Annual Membership Fee |
| Donation: | |