Name ___________________________________________________________________
Street____________________________________________________________________
City _____________________State ____________________Zip ___________
Phone: Daytime ___________________________Nighttime __________________email address_________________________________________________________
This is for:
_______________New membership
_______________Renewal membership
_______________Individual at $18.00
_______________Couple at $31.00
Make checks payable to:
Palouse Chapter
PO Box 8274
Moscow, ID 83843