(Mr, Ms, etc.)_________ ______________________________ Gender_______ Birth Year 19____ Title Name
Address_________________________________________________________ Apt #_________ City, State, Zip_______________________________________________________________ I learned of this Society from_________________________________________________ Occupation_______________________________________ Phone #______________________ My local Only for foreign o North o East time zone________ Countries: I live______km o South o West __________________ of this large city Comments_________________________________________________________________________ _________________________________________________________________________
Membership to end of year (or following year if after Sept. 30), $3.00 ($6 = 2 years, $9 = 3years).
Includes Forecast times, and Newsletters when published, usually four per year.
Newsletters can be emailed to you rather than by postal service.
Email us (dinshahhealth@aol.com) if you wish delivery in this manner.

Date_____________________________ Signed________________________________________