| SUNSET CHAPTER OF ABATE OF OKLAHOMA, INC. |
| MEMBERSHIP APPLICATION FORM |
| MEMBER NAME: ______________________________________________________ MEMBERSHIP NUMBER: _______________________________________________ DATE OF BIRTH: ______________________________________________________ ASSOCIATE NAME: ____________________________________________________ ASSOCIATE NUMBER: _________________________________________________ DATE OF BIRTH: ______________________________________________________ ADDRESS: ____________________________________________________________ CITY: _____________________ STATE: ___________________ ZIP: __________ PHONE: ______________________ E-MAIL ADDRESS: ______________________ FULL MEMBER: $ 20.00 __________ ASSOCIATE MEMBER: $ 10.00 __________ FULL & ASSOCIATE MEMBER: $ 30.00 __________ NEWSLETTER ONLY: $ 12.00 _________ FOR QUESTIONS REGARDING MEMBERSHIP - PLEASE CONTACT: SUZANNE BASHAW, MEMBERSHIP CHAIRPERSON sunsetabate@yahoo.com PRINT & MAIL THIS FORM ALONG WITH YOUR CHECK TO: SUNSET CHAPTER ABATE P. O. BOX 1172 EL RENO, OK 73036 |