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This
form is temporarily disabled until connections between the web master and the
treasurer can be made. Please use our printable form and mail your information
in. Sorry for the inconvenience.
Is
this a new membership?
If yes, have you received your membership patch?
If
you are renewing your membership what is your membership number:
Your Name:
Address,
City, State & Zip:
Day
Time Telephone:
Evening Telephone:
Your
E-Mail Address:
If
you want membership for additional people in the same household please enter their
names. This means spouse, children or "significant other" living
in the same house - NOT roommates, insignificant others or simply people
you hang out with.
Names:
i.e. Susan, Gary, Matt
Membership
Requested :
Total
number of new members:
Total
number of renewals:
Additional
contribution to SE Chapter Programs:
I
will be paying for my membership and contribution:
Paying on line: Our PayPal links will pop up on the
thank you page. Please click on one of the PayPal links which will take you to
our form on the PayPal web site where you will be able to submit your payment.
Mailing Payment: If you are mailing your payment
please mail it to the address listed on the thank you page. Please send a note
with your payment that you submitted your membership application on line.
All Payments: If
payment is not received within 10 days of your submitting this on line membership
application your application will be deleted and you will have to re-submit.
What
is your Congressional voting district?
What
is your Senatorial voting district?
What
is your Representative voting district?
Comments
& Questions:
This
form is temporarily disabled until connections between the web master and the
treasurer can be made. Please use our printable form and mail your information
in. Sorry for the inconvenience.
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