Please
Select A Membership
Please
choose either one adult membership
or one youth membership at one time.
Adult Memberships
Regular Adult
$30
Silver Life Membership
$750
Youth
Memberships
Youth w/o Crisis Magazine
$10
Youth w/ Crisis Magazine
$15
Junior Life Membership
$100
Bronze Life Membership
$400
Date of Birth
Required For Youth Memberships
Example 09/04/75
Member Information
Please enter the the following information, as you
would like it to appear on your membership card
Salutation
Mr.
Mrs.
Miss
Ms.
Dr.
Rev.
First Name
Middle Initial
Last Name
Lineage (Jr. Sr. Etc.)
Suffix (Degrees, etc)
Mailing Address
City
State/Province
ZIP/Postal Code
Email
Phone (Day)
Phone (Evening)
Fax
Unit Affiliation
Registered Voter?
Yes
No
I would Like To Join The ---Committee
I'm Not Sure (More
Info)
You may pick more than one committee.
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