Name:

Address:

City: State: Zip:

Country (if other than USA):

I wish to pay by : <choose one> Personal Check Money Order Visa Mastercard

Card Number:

Expiration:

CVC number: (trailing three digit number on back of card)

OPTIONAL INFORMATION

Evening Phone: Day Phone:

E-mail address:

Membership classes and dues: (check one)

If you wish, you can "lock in" these rates by paying for two years at once. (Amount is twice the one year rate.)

REGULAR ($35.00) Provides all regular N&WHS benefits for one year.

SUSTAINING ($50.00) Includes all regular N&WHS benefits for one year AND provides additional support for the work of the Society. Any amount over regular membership is tax-deductible in the USA.

INTERNATIONAL ($50.00) Includes all regular N&WHS benefits for one year and includes the cost of mailing outside the US.

INTERNATIONAL SUSTAINING ($65.00) This option gives our international members the opportunity to provide additional support.