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.