| A non-profit, scientific, educational, membership, corporation |
PO Box 707 Malaga NJ 08328 USA (856) 692-4686 |
(Mr, Ms, etc.)_________ _________________________ Birth year 19______ Gender_______
Title Name
Address_________________________________________________________ Apt #_________
City, State, Zip_______________________________________________________________
I learned of this Society from_________________________________________________
Occupation_______________________________________ Phone #______________________
My local Only for foreign o North o East
time zone________ Countries: I live______km o South o West __________________
of this large city
Comments_________________________________________________________________________
_________________________________________________________________________
Membership to end of year (or following year if after Sept. 30), $3.00 ($6=2 years)
Date_____________________________ Signed________________________________________
| #1: Spectro-Chrome information package: items A, F, N | @ $20________ |
| #2: Spectro-Chrome information package: items I, F, N | @ $23________ |
| #3: Spectro-Chrome information package: items A, F, O (PAL) | @ $35________ |
| #4: Spectro-Chrome information package: items I, F, O (PAL) | @ $38________ |
| #5: Add to price of any Info package if item M is also desired. | @ $12________ |
| #6: Add to price of any Info package if item P is also desired. | @ $10________ |
Updated 1-24-08