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Printable Membership Form
Fill in your information and  print and mail with your check or credit card information to the address below.

First Name
Last Name
Address
Other Address
City
State or Province
Zip or Postal Code
Telephone Number
Email Address
Name & your address for enclosure if this is a gift membership
Local Club Name

Please choose one type of membership

Single, 1 year (12 mo)

$25.00

$
Joint, 1 year (12 mo)

$27.50

$

If you live outside the US, please choose one
shipping method per year for your postal zone

If outside US, choose Air

Air

Canada, Mexico
$14.95
South America

$27.45

UK, Europe

$27.90

New Zealand, Australia

$30.90

Pacific Rim, Africa, Russia

$27.90

$

Other memberships (if outside U S, please add applicable air or surface shipping to all but life memberships.

Single, 2 years (27 mo)
$50.00
 $
Single, 3 years (42 mo)
$75.00
 $
Joint, 2 years (27 mo)
$55.00
 $
Joint, 3 years (42 mo)
$82.50
 $
Sustaining (1 year)
$50.00
 $
Patron (1 year)
$125.00
 $
Life single
$500.00
 $
Life joint
$550.00
 $
Life single, outside US
$560.00
 $
Life joint, outside US

$620.00

$

Total payment in U.S. dollars

$

Check
no:

Credit card:

VISA or
MasterCard

Card no: Exp date:

Mail to:100 Massee Lane Rd
Fort Valley GA 31030
478-967-2358, FAX: 478-967-2083

Click here to print this page

Your name, address, telephone number, and email address will be published in the annual Yearbook unless you tell us not to do so.
Page updated: 10/07/2002