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Membership and Donation Form Annual dues are $15 per person; please write a check for the amount of dues. Make check payable to: Stonebelt Stargazers and send your remittance to: P.O Box 1112, Bedford, IN. 47421, 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. Name__________________________________________________________ Address________________________________________________________ City______________________________ State_______ Zip_______________ Home Phone____________________________ E-mail__________________________________________________ [ ] Membership Dues [ ] Donation Enter Total________________________________ 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. |