Name:__________________________________________
Address:_______________________________________
City:___________________________________________
State:__________________________________________
Zip Code:_______________________________________
Country:________________________________________
Phone:_________________________________________
E-Mail:__________________________________________
Annual Dues
Due January 1
________________ $25.00 Capitan (Regular)
________________ $12.00 Soldado (Student with ID)
________________ $35.00 Cura (Institutional)
________________ $40.00 Pareja (Couple)
_______________ $50.00 Coronel (Sustaining)
________________ $100.00 Virrey (Corporate)
_______________________ Donations and Gifts
Please Make Checks Payable To:
The Anza Society Inc. and Mail To:
The Anza Society, Inc.
Sharon Myers, Secretary
12250 N. Tall Grass Drive
Oro Valley, AZ 85755
A receipt will be sent to you for your dues, donations or gifts.
| The Anza Society, Inc Membership Form |
