FRIENDS OF NACPM MEMBERSHIP FORM

I WANT TO JOIN! (Please print and mail this form along with your donation.)

NAME_______________________________________________________________________________

STREET ADDRESS____________________________________________________________________

CITY_____________________________STATE/PROV___________ ZIP/POSTAL CODE_____________

HOME PHONE__________________________SECOND PHONE_______________________________

E-MAIL ADDRESS _____________________________

(When we use e-mail to communicate with you it lowers the overhead for the organization and protects our funds for other work.)

$___________ gift to NACPM-Any amount would be greatly appreciated!


WE GREATLY APPRECIATE YOUR SUPPORT!

Please mail this form with your check or money order made out to NACPM to:

Adriana Elliot
PO Box 340
Keene, NH 03431