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.
Dave Jeffries Treasurer
12112 Rancho Vistoso Blvd, Suite 150. PMB 146
Oro Valley, AZ 85755
A receipt will be sent to you for your dues, donations or gifts.
| The Anza Society, Inc Membership Form |
