SELF SEEKERS:

The Self Family Association TM(R)

P.O. Box 291872
Phelan, CA 92329-1872

Please help us meet our operating costs
Thank you!

Membership Application

NAME: ____________________________________________________________________

STREET/PO BOX: ___________________________________________________________

CITY/STATE/COUNTRY: _____________________________________________________

E-MAIL ADDRESS: __________________________________________________________

TYPE OF MEMBERSHIP (please check one):
REGULAR [ ]                                              CHARTER [ ]                                       PATRON [ ]

MEMBERSHIP IS FOR (please check one): INDIVIDUAL [ ]        FAMILY [ ]

(If you checked Family Membership, please list names of family members and relationship to you.)

  1. 1. (YourSelf)________________________________________________________
  2. 2. ________________________________________________________________
  3. 3. ________________________________________________________________
  4. 4. ________________________________________________________________
  5. 5. ________________________________________________________________
  6. 6. ________________________________________________________________

EARLIEST KNOWN SELF ANCESTOR: _________________________________________

MEMBERSHIP

BASIC: ...................Basic membership Benefits include:

REGULAR ..............Regular membership status entitles the member to all of above plus online newsletter
                                                                         Annual contribution $12.00 SEE SPECIAL OFFER ABOVE

CHARTER ...............Charter membership entitles the member to all of the above, plus mention on our contributors' page
                                                                         Annual contribution $25.00 SEE SPECIAL OFFER ABOVE

PATRON...............Patron membership entitles the member to all of the above, plus our grateful appreciation
                                                                             Contribution: $100.00+ SEE SPECIAL OFFER ABOVE

Family membership is available at no additional cost and includes spouse and children under age 21

HOW TO APPLY FOR MEMBERSHIP

Make a printout of the membership form, fill it out, and send it, along with your check or money order in U.S. Currency to:

SELF Seekers
P.O. Box 291872
Phelan, CA 92329-1872

We accept personal checks. Please make personal checks payable to: Barbara Ann Peck.

Please address questions and comments to Webmaster

Back to Self Portraits


This page was last updated on Aug. 28, 2004