Membership Form

Annual: Single  ( )  $10.00    Joint ( ) $15.00

5-Year: Single  ( )  $40.00    Joint ( ) $60.00

Endowment Fund:  ( )  $ ________

Academic Scholarship Fund:  ( )  $ ________

Athletic Scholarship Fund:  ( )  $ ________

Any amount received above dues will be considered a contribution toward the endowment fund.

Name : _______________________________________

E-mail: __________________

Address:
_______________________________________________________________

_______________________________________________________________

Telephone number:
______________________________________________________

Class Yr: ___________________