Today's Date:  _____________________ 
(membership year is from October to October)

Name:  ____________________________________________________

Street: _____________________________________________________

City, State & Zip:  ___________________________________________

Phone:  ______________________ E-mail:  _______________________
 

Active or Associate Membership:  New _____  Renewal _____

*Individual  ($10.00) _____; Family ($15.00* one household) _____.

Individual Sustaining Membership ($25.00) _____; Individual Life Membership ($150.00) _____.
 

*If Family Membership, please write all the names of those you wish to include with this Annual Dues form, and their relationship to you.  In this instance, the term "family" refers to those living in one household.

*IF YOU ARE AN ASSOCIATE MEMBER, (friends of the Raynors), PLEASE CIRCLE THE WORD "ASSOCIATE" ABOVE.
 

             MEMBERSHIP TOTAL ENCLOSED $_____________ 
           (Make checks payable to the Raynor Family Association)
 

If at any time, you wish to pay for another persons' annual dues, outside your own family membership unit, please indicate and include a separate dues form, or the full name and address of that person or persons and type of membership with the check.

Thank you very much, 

Jeanne Raynor
Membership Chairperson