Please Check One -

(   )   $10  Household Mermbership   ___________ number of adults in household included in this membership

(   )    $25 Business membership

I ( do  - do not) wish my name to appear on the public membership list.  (note: no contact will ever be included)

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name(s) as to appear on mailing label

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address

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phone                                             email

For the purpose of our having an accurate membership vount, please list all household membbers. Thank you.

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