I Accept!

(Please print out this form to join the Friends)

Name_________________________________________

Address_______________________________________

______________________________________________

Phone
Home___________________ Work________________

E-Mail_______________________________________

I would like to help with:
___ Advocacy  ___ Membership ___ Mailings  ___ Newsletter

___ Publicity  ___ Special Events

My annual dues at the following membership level are enclosed:

___ Senior (65 +)  $5

___ Individual  $ 10

___ Family  $ 25

(includes one or two adults and all children 18 years or younger) 
Please list names and ages of children:
_________________________________________________________________________________________

_________________________________________________________________________________________

___ Business/
Professional $ 35

All contributions are tax deductible
to the full extent of the law.