| Name(s)_______________________________________
Address________________________________________ |
Phone
(Home)__________________________________
(Work)_________________________________________
eMail___________________________________________
|
|
I/We
wish to join JACO. (Please circle $ amount.)
| Category |
1-Person |
2-Persons |
| Basic
Membership |
$45 |
$70 |
| Student
(full-time) |
$25 |
$50 |
| Sustaining |
$100 |
$150 |
| Patron |
$250 |
$350 |
| Associate
(Mailing List) |
$25 |
|
I have enclosed $________to cover dues.
Please mail form (check payable to)
JACO, 59 W. Third Ave., Columbus
OH 43201
|
I
wish to pay by:
_____Visa _____MasterCard
_____Discover
Card#___________________________________________
Expiration Date__________________________________
Signature_______________________________________
Date____________________________________________
Your
membership is tax deductible.
|