VOSH NORTHWEST

15617 NE 91^st Way

Redmond, WA 98052-7528

APPLICATION

NOTE: To join VOSH Northwest, make you tax deductable contribution of $30.00 by printing this form, filling it out and mailing to the address above.

Date: ________ DUES: _$30.00_____

NAME:________________________________________________

(how you want your name listed)

ADDRESS:_____________________________________________

CITY,STATE,ZIP:________________________________________

Please List contact phone # :( )____________ FAX # :( )___________

E-Mail:_________________________________

Make checks to VOSH-NORTHWEST and mail to the above address