Name:
Address:
City:		State:
		Zip:
Day Phone:		Work Phone:

I am enclosing:  $
Enroll me as a FRIEND (please mark one):

$    5.00 - Annual Senior Membership (55 Years +)
$  10.00 - Annual Individual Membership
$100.00 - Lifetime Membership

Please check areas of special interest to you.

FRIEND TEAMS

Advocacy
Fundraising/Booksale
Homebound delivery
Hospitality
Membership
On-site volunteer
Program planning
Publicity/Newsletter

Is there any area in which your training or experience has given you special knowledge? What are your specialties:

Please check if you prefer to be a "Quiet Friend" and do not want to be actively involved in programs.