Please PRINT form and mail:
Membership Fees: $20.00 per year (October – September)
Name: ___________________________________________________
Address: _____________________________________________________
City, State, Zip: ________________________________________________
ADA#: _______________________________________________________
Email: _______________________________________________________
Phone(s): ____________________________________________________
Company: ____________________________________________________
Mail Membership to:
Jodi Roth, DTR
PO Box 312
Rainer, OR 97048-0312