MAKE CHECK PAYABLE TO THE ABOVE ADDRESS:
+++++++++++++++++++++++++++++++++++++++++++++++++++++
MEMBERSHIP CATEGORIES'
SPONSOR (
) $25
STUDENT ( ) $10
GREAT BENEFACTOR ( )
$500, or more
BENEACTOR ( )
$75 PATRON (
) $50
Total Amount ___________________
+++++++++++++++++++++++++++++++++++++++++++++++++++++
NAME
____________________________________________________________
ADRESS __________________________
CITY __________________
STATE _________________
ZIP __________ TELEPHONE NO. ______________
EMAIL
_____________________________________________________________