Membership Type:

( __ ) Single $20.00

( __ ) Family $25.00

(Family membership includes spouse & children under 18)

Note: If you belong to another club that has paid your AWSC dues, you may deduct $10.00 and enter the name of that club: _______________________________

Date: ______________________

Amount Enclosed: ________________

Single Member (or Member #1) Member #2 (if a family membership) Number of Children Ages Address City/State/Zip Home Phone ( __ ) Check if you DO NOT want your number in the club roster. Other Phone   E-Mail address ( __ ) Check to receive your newsletter by e-mail