Membership and Donation Form
Membership dues are as follows;
$10---Student (elementary, high school, college)
$30---Couple (husband & wife)
$40---Family of 4 (husband, wife and 2 children)
Please write a check for the amount of dues.
Make check payable to: Stonebelt Stargazers and send your remittance to:
c/o Bill Johnson
765 South Grandview Drive
Paoli, IN 47454
If more than one person is joining please enclose additional form/s. If making a donation Please fill out form so we can send a receipt to you for tax purposes.
City______________________________ State_______ Zip_______________
[ ] Membership Dues [ ] Donation
The information contained on this form will go into the club directory which is available to club members only; we will not sell our membership list. Donor information is available to club officers only.