MEMBERSHIP INFORMATION FORM
Membership dues per household are only $25 per year.
New memberships paid after October 1st will include the next calendar year.
Your Name:___________________________________________________________________________
Other name, same address: ______________________________________________________________
Street Address: ________________________________________________________________________
City, State, Zipcode:_____________________________________________________________________
Telephone: ____________________________________________________________________________
Email Address: _________________________________________________________________________
How You Learned About AGSSSC: __________________________________________________________
_______________________________________________________________________________________
Collecting interest: _______________________________________________________________________
_____ I have enclosed $25 for annual membership.
_____ I give permission for the above information to be included in the AGSSSC
Membership Directory unless otherwise requested.