Membership and Subscriptions: Mail form
Please print this form, complete the requested information, and mail it with your payment to:
PCAS Membership
P O Box 10926
Costa Mesa, CA 92627
Memberships and subscriptions are for the 2010 calendar year.
Name: ________________________________________________________
Street address: _________________________________________________
City: __________________________________________________________
State: _________________________________________________________
Zip: ___________________________________________________________
Phone: _________________________________________________________
Email: _________________________________________________________
I have read and agree to abide by the PCAS Code of Ethics.
(signature) __________________________________________________
Membership |
|||
| Please check one: | |||
| Active member | $45 | _____ | (All members receive the Newsletter and Quarterly.) |
| Active family (2 persons) | $50 | _____ | |
| Supporting member ($55 or above) | _____ | (Supporting, Donor, and Lifetime categories may be individual or family memberships.) | |
| Donor member ($75 or above) | _____ | ||
| Lifetime member | $1,000 | _____ | |
| Student Associate | $10 | _____ | (Student Associates receive the email PCAS Newsletter [no Quarterly] and have no voting rights. Please submit proof of student status.) |
| Subscriptions only | |||
| Quarterly only | $37.00 | _____ | |
| Newsletter only | $18.00 | _____ | |
| Both publications | $55.00 | _____ |
_____ Yes, I would like to receive the Newsletter by email ________________________
Please be sure email address is legible.
_____ I want to make an additional donation to scholarship fund of $ ____________