Membership Form

Please use this form to pay by check, via snail mail.

Personal information:

Name:	_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _	NAWCC #:	_ _ _ _ _ _ _ _ _ _ _
Family Member:	_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _	NAWCC #:	_ _ _ _ _ _ _ _ _ _ _
Address:	_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
City:	_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
State:	_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _	Zip:	_ _ _ _ _ _ _ _ _ _ _
Phone:	_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _	Email	_ _ _ _ _ _ _ _ _ _ _

Membership information:

Individual memberships, ($15 USD per year)	_ _ _ _ _ _	SubTotal:	_ _ _ _ _ _ _ _
Family memberships, ($16 USD per year)	_ _ _ _ _ _	SubTotal:	_ _ _ _ _ _ _ _
International memberships, ($20 USD per year)	_ _ _ _ _ _	SubTotal:	_ _ _ _ _ _ _ _
Lifetime memberships, ($150 USD)	_ _ _ _ _ _	SubTotal:	_ _ _ _ _ _ _ _
		Total:	_ _ _ _ _ _ _ _

To Pay By Check:

Print out and complete this form.
Make check payable to "Alarm Clock Chapter #178"
Mail both to our Treasurer:

Mike Wilson
15508 East Chaparral Way
Fountain Hills, AZ. 85268
Email: mike@oldephotog.com

All memberships are on a calendar year basis, good from January 1 to December 31 of the year membership is applied for. Yearly membership entitles the member to all newsletters and handouts published during the calendar year.