Junior New Membership

Use this form only if you are joining as a new Society member.
Credit Card or Check Holder's Information:
Name:
Address:
City:
State:
Zip:
Country:
Phone #:
Email Address:

Enter New Member's Information Here:
Name:
Address:
City:
State:
Zip:
Country:

Junior Member's Birth Date:

If a Society Member has recruited you enter their Membership Number or Name below. Or if you are a member signing up a new member please enter your membership number below. The recruiter will receive a voucher good for $5.00 off their next renewal:
Membership Number or Name to Receive Voucher:

Choose One:
$28.00 Classic One Year (Benefit: Porcelain Brooch)
$80.00 Choice One Year (Benefit: Sterling Silver Bead)
$95.00 Premier One Year (Benefit: Porcelain Brooch and SS Bead)
$500.00 Premier Gold Upgrade One Year (14k Gold Bead)

Notes: