SCAN Memberships and Donations
Membership Year June 1- May 31
Make check payable to SCAN, Inc. & mail to: SCAN Membership/Donations P.O. Box 41 Newtown, CT 06470
Print this form out using "Print Form" button at bottom if you wish to mail a check along with the form. You may also opt to click the "Submit" button at bottom to submit electronically (no need to print!), and mail a check separately.
Name
*
Street
*
City
*
State
*
ZIP
*
Phone
*
including area code
Format: (000) 000-0000.
E mail
*
example@example.com
E-mail
I opt for electronic version of Newsletter
Annual Dues June 1 through May 31
Choose any or all that apply by entering dollar amount in field (do not add $ symbol, only numbers):
Individual $25
Full time Student $10
Family $35
Patron $50
Life $250
Donations:
Enter a Dollar amount in field you wish to donate to (do not add $ symbol, only numbers):
Laurence Newquist Student Scholarship
Awards/Prizes
Undesignated
TOTAL ENCLOSED (MEMBERSHIP + DONATION)
*
Please check the activities or committees you wish to help with:
Hospitality
Show Receiving
Show Sitting
Publicity
Membership
Demonstrating
Other
Make check payable to SCAN, Inc. & mail to: SCAN Membership/Donations P.O. Box 41 Newtown, CT 06470
Print this form out using "Print Form" button below if you wish to mail a check along with the form. You may also opt to click the "Submit" button below to submit electronically (no need to print!), and mail a check separately.
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