Name:_____________________________________________________________________________________

Street Address:______________________________________________________________________________

City:____________________________State:______________Zip:____________________________________

Business Phone:_____________________________Home Phone:_____________________________________

Email Address:______________________________________________________________________________

Membership Type:

___ Member $100

___ Business Sponsor $500

___ Gold Sponsor $1,000

Contributions and participation are especially appreciated in this volunteer organization. Please consider the following items:

Please list activities in which you would like to participate or organize:

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_________________________________________________________________________________________

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Please list skills or abilities you would like to share on behalf of the Association:

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