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Society Member - $ 100.00

Society Friend - $ 500.00

Society Patron - $ 1,000.00

Society Sponsor - $ 5,000.00

Society Benefactor - $ 10,000.00

Society Young Patron - $ 500.00

Young Society Sponsor - $ 2,500.00

Society Young Benefactor - $ 5,000.00

Please renew my membership automatically.

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Note

Name and Address

First Name *

Last Name *

Street Address (Home)

City (Home)

Postal Code (Home)

Country (Home)

State (Home)

Phone Number *

Credit Card Information

Card Type

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Expiration Date *

My billing address is the same as above

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

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Postal Code *

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