FIRST NAME:

LAST NAME:

Company/Title:

ST. Address1:

ST. Address2:

CITY:

STATE:

ZIP CODE:

COUNTRY:

Email:

Tel # :

Membership:

Law Enforcement,Military,Govt,Individual 1yr $65     2yr $120
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Corporate and Institution (libraries)         1yr $75     2yr $140
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Student Membership                         1yr $40     2yr   $70
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Important! all overseas Membership Orders add $15    
                  

PAYMENT METHOD:

Visa Amex Mastercard PLEASE SELECT Credit Card Check Money Order

CREDIT CARD #:

EXPIRATION DATE:

Your Signature Here:
 

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