| Membership Levels |
| Renewal | New Member |
| $60 Individual (Basic Membership) | |
| $90 Household (2 members living at the same address) | |
| $25 Student Membership | |
| *Scholarship monies are available and will remain an anonymous gesture |
| Donation |
| $50 Supporter) | |
| $75 Friend | |
| $100 Patron | |
| Other |
| Name: | _________________________________________________________________ |
| Address: | _________________________________________________________________ |
| City: | ____________________________________ |
| State: | _______________ |
| Zip: | _______________ |
| Phone: | _______________ |
| E-Mail: | _________________________________________________________________ |