DCHS Membership Application
Membership Level
Annual Dues
Individual Member
$10.00
Family Member
$20.00
Organization Member
$30.00
Sustaining Member
$50.00
Business Member
$75.00
Name: _____________________________________
Address: ___________________________________
City: _______________________________________
State/Prov: ________
Zip/Post Code: _________
Country: ___________________________________
Phone: ____________________________________
Email: _____________________________________
Method of Payment: Check Money Order
Tax Deductible Donations also accepted. Enclose with your application or mail separately to DCHS at the address above. Thank you.
DCHS Membership Application | |||
Membership Level | Annual Dues | ||
Individual Member | $10.00 | ||
Family Member | $20.00 | ||
Organization Member | $30.00 | ||
Sustaining Member | $50.00 | ||
Business Member | $75.00 | ||
Name: _____________________________________ | |||
Address: ___________________________________ | |||
City: _______________________________________ | |||
State/Prov: ________ | Zip/Post Code: _________ | ||
Country: ___________________________________ | |||
Phone: ____________________________________ | |||
Email: _____________________________________ | |||
Method of Payment: Check Money Order |
Tax Deductible Donations also accepted. Enclose with your application or mail separately to DCHS at the address above. Thank you.