| Membership Status |
New ( ) |
Renewal
( ) |
(please check one) |
| One
year $5.00 ( ) |
Five
years $20.00 ( ) |
Life
Membership $100.00 (
) |
| Name |
____________________________________________________ |
||
| Street/POB |
_____________________________ |
||
| City/Town |
_____________________________ |
State
_______ |
Zip+4_________ |
| Telephone |
_____________________________ |
Email_____________________ |
|
Mail to: MOCA
Membership Chairman
P.O. Box 641
Augusta, ME 04332-0641