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Membership Form Annual Dues June 1 through May 31

  


Name.
Street.
City....
State.. Zip
Phone
Email.

 
Membership type
Individual ..............................$20............$
Full-time Student ................$10..... ... . $
Family ................................. $30............$
Patron ................................. $50............$
Life ...................................... $250..........$

Other contributions

Laurence Newquist Student Scholarship
Awards/prizes

$
$

TOTAL ENCLOSED .$

   
Please make checks payable to SCAN, Inc. and mail to:

SCAN Membership Chair
PO Box 41
Newtown, CT 06470

Please check the activities or committees you are willing to help with
Hospitality
Show receiving
Show sitting

Publicity
Membership
Demonstrating

Other (please specify) ______________________________________________________