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Application for Membership We hope you will join Hemlock Society of San Diego. Please print this page (click FILE-PRINT) and send it with your check made out to HSSD to the following address: HSSD PO Box 34237 San Diego, CA 92163 Hemlock Society of San Diego A non-profit tax-exempt 501 (c)(4) independent organization Choose one: 1-year membership Individual ______ $25 Couple ______ $40 Life membership Individual ______ $250 Couple ______ $400 ____ I would also like to support HSSD with an additional donation of $_________. ____ I may be interested in including HSSD in my Will or Trust. Please contact me to discuss this further. Name(s): _______________________________________________________ Title(s): ________________________________________________________ Address: _______________________________________________________ City: ___________________________ State: _____ Zip: ________________ Phone: ________________________ Email: __________________________ Comments (optional): _____________________________________________ ______________________________________________________________ |
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