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MEMBERSHIP DUES - JANUARY 1 THROUGH DECEMBER 31
(       )	Individual Membership	$25.00
(       )	Student membership ( Ages up to 18)	$5.00
(       )	Business Membership	$25.00
Please indicate if you are qualified to:     Teach   ________       Lecture   ________    Demonstrate    ________
Please indicate if you are interested in exhibiting at Brick Hospital   Yes____        No_____
Would you be interested in volunteering in any of the following areas?

(       )Brick Hospital Gallery	(       )Planning Committee - Annual Dinner
(       )Refreshment Committee for Monthly Meetings	(       )Planning Committee - Trips
(       )Administrative Help - Membership	(       )Planning Committee - Workshops
(       )T-Shirt Project	(       )Planning Committee - Exhibits
(       )Scrap Book / Historian

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