Name:_____________________________________________________

Address:_____________________________________________________

City: __________________________  State: ___  Zipcode:_____

Email:____________________@___________________________

Telephone:(____) ____-______

Membership type: (Please check one)

_____  Life-Individual - $500.00

_____  Annual-Individual - $20.00

_____  Annual-Family - $30.00

______  Send the quarterly newsletter to my email address.

______  Send the quarterly newsletter to my home address.

Please send your completed application and payment (cash or check made payable to MAHS) to: