GPPA Friend of the Community Form

Name:        E-mail:

Spouse:    Fax:     

Address:

City:        Zip Code:

Daytime Phone: E-mail

Choose a Membership/Friend Level:

$ 40 Individual & Family $ 80 Business & Organization

Please don't send magazine
I would like to make a tax deductible donation of $

Payment Information

I am paying by check and have enclosed my check made payable to GPPA.

Please bill my MasterCard or Visa credit card. My credit card information is:

Name on Card    Credit Card #  

Verification # (3 digits on back of card) Exp. Date: Zip Code:
 

Additional Information

Community (Association):  

Summer Address:               

Dates of Summer Address:

New Member:    Membership Renewal:

Comment: