NEW MEMBERSHIP APPLICATION

NEW MEMBERSHIP APPLICATION

PAY ONLINE WITH CREDIT CARD OR PRINT & MAIL WITH PAYMENT TO: P O BOX 526 COCOLALLA , ID 83813
DATE*

MonthDayYear
NEW APPLICATION Pending Approval)RENEWAL
NAME*
COUNTY
ADDRESS*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
CELL PHONE
Please enter a valid phone number.Format: (000) 000-0000.
ALTERNATE PHONE
Please enter a valid phone number.Format: (000) 000-0000.
EMAIL*
example@example.com
Cell PhoneAlternate PhoneEmailText
Community ProjectsEventsFund-RaisingHospitalityMarketing & Graphics 5PublicityWebsiteOther
BIRTHDATE
MONTH DAY YEAR

MEMBERSHIP TYPE Select Membership Type

REGULAR MEMBERSHIP

Regular Members may speak, vote, hold office, and serve on committees.

$35.00 Quantity

SUSTAINING MEMBERSHIP

Features the same benefits as Regular Members. Payment includes a $5 donation toward the operational expenses of the group.

$40.00

ASSOCIATE MEMBERSHIP

$20.00

Total

$0.00