1. Your Name_________________________

2. In which county do you reside?______________________

3. Your email address____________________

4. Your snail mail address____________________________________________

5. Please check items below which are appropriate

   ____ Please send information on how to become a chapter member

   ____I am interested in a position with the Washington State Cemetery Association Executive Board

   ____I am interested in overseeing a cemetery clean-up

   ____I am interested in helping a clean-up crew as my schedule permits

   ____I am interested in working on a committee to write new legislation

6.  Signature and date____________________________________________________

Print and complete this form.  When done, send the form along with a check or money order for $12 ($6 students) for an individual membership to the address below.  

Washington State Cemetery Association
P. O. Box 103
Port Orchard, WA 98366