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Affiliate your NOW membership

NOW







Print this form to affiliate your membership with the local chapter.  Thanks!




I want to immediately affiliate my NOW membership with FL0345:

Fill in the numbers in the pink shaded box from your Membership card: (required)

Member No. (first number): 

Your Name(as it currently appears in our records, so we can make sure we match your membership record correctly)
First Name:    Last Name: 

 
Address Correction:

If your address has recently changed, please let us know.
First Name (if new): 
Last Name (if new):  
Mailing Address: 
City: State: 
Zip:   Country:
Daytime Phone:     FAX:    
Evening Phone:     
E-mail address:
     Example: pat@nowworld.org

Change chapter affiliation to:  FL0345 


 this form and send it to:
Sarasota-Manatee NOW
P. O. Box 2972
Sarasota, FL 34230
(800) 301-8604

JVB/DRBD 20 Nov. 2005

Internet renewal form