| Name:_________________________________________ | Amount $____________________ |
| Address:_______________________________________ | Phone (_____)________________ |
| ______________________________________________ | Spouse's 1st Name: _______________________ |
| ______________________________________________ | E-Mail Address: _______________________ |
| ______________________________________________ |
Cut and Mail Dues to: Frank Vasquez; 1953 King Arthurs Court; Winter Park, Florida 32792