Name ____________________________________________________________________________

Address___________________________________________________________________________

City____________________________________________________Prov_______________________

Country__________________________________________Postal Code_______________________

Phone (Res)____________________________________________(Bus)_______________________
                                                                                     Do you wish to recieve your
Email address____________________________________  Newsletter by email______yes______no

Please check type of membership                                   Annual Fees

[  ]    Individual, one year                                                 $  25.00
[  ]    Individual, five years                                                $110.00
[  ]    Family, one year                                                      $  30.00
[  ]    Family, five years                                                     $130.00
[  ]    Organization, one year                                            $100.00

Additional Donation (not including Membership fee)
[  ]    Donation (tax deductible)                                        $_______________