Membership Form

Name_______________________________________________________________________________

Address_____________________________________________________________________________

City & State_________________________________________________________________________

Phone Number (Home)_____________________________ (Work)____________________________

___membership dues -$10.00

___ I would like to contribute an additional amount $___________

____I do not want to be a member, but I want to contribute $_____________

____I would like to receive a volunteer application

Please complete This Form, Enclose your membership dues and return to: AVNK, P.O. Box 175743, Covington, KY 41017-5743.

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Webmaster: Michael L. Connley, e-mail: mconnley@cinergy.com
Date Revised: Saturday, September 05, 1998