Name: _________________________________________________________
Address: _______________________________________________________
City/State/Zip: ____________________________________________________
Telephone: Home: _____________________ 
Work: _____________________ Cell: _____________________
Email Address: __________________________________________________
Are you a SASS Member? ____________  If so, please include...
SASS #: _________________SASS Alias: ______________________________

Type of Membership (check one):  ____ Individual ($15/year)  ____ Family ($22/year)
If family, please fill in family member name and relationship (spouse - child) and SASS info (if any).
    Name: ______________________________ Relationship _________________
    SASS #: __________________ Alias: ________________________________
    Name: ______________________________ Relationship _________________
    SASS #: __________________ Alias: ________________________________
    Name: ______________________________ Relationship _________________
    SASS #: __________________ Alias: ________________________________
    SASS #: __________________ Alias: ________________________________
    Name: ______________________________ Relationship _________________
    SASS #: __________________ Alias: ________________________________
    Name: ______________________________ Relationship _________________
    SASS #: __________________ Alias: ________________________________

Please send this completed form with payment to: