Membership Application

Individual Membership
(over 18 years old)
$  45.00
Family Membership
(includes children up to 18 years old)
$  65.00
Junior Membership
(under 18 years old)
$  25.00
Sustaining Membership $  55.00
Supporting Membership $  90.00
Sponsoring Membership $  160.00
Life Membership $  425.00

Name: __________________________ Age: ______
Address: ___________________________________
City: ______________________________________
State: ____________________ Zip: ___________
A $5 Subscription to the NETRA News is included in the Annual Dues.

Mail this form with payment made payable to NETRA.

NETRA
Post Office Box 469
Collinsville, CT 06022