2003 - INDIVIDUAL MEMBER

APPLICATION FOR INDIVIDUAL MEMBERSHIP

Name:______________________________________________________________

Address: __________________________________________________________________

Phone: _____________________________ Fax: ___________________________________

Email Address: ___________________________________________

Please print this form, complete it and return it to our office with a check for $300.00.

Contributions or gifts to PSVOA/ASBO are not tax deductible as charitable contributions for federal income tax purposes. However, they may be deductible under other provisions of the Internal Revenue Code.