Check appropriate boxes and send total payment.

County Dues (please select):

Klamath		________		$5		__________
Jackson		________		$5		__________
Harney		________		$20		__________
Umatilla		________		$5		__________
Baker		________		$5		__________
At Large		________		$0		__________
State Dues				$25		__________
National (Optional)				$50		__________
Sustaining				$75		__________
TOTAL $						__________

County Treasurers may collect and deposit county dues and forward state and national (ANCW) dues to Susan. If no county affiliation forward directly to Susan. Thanks for your membership.

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