NPLC MEMBERSHIP

NPLC ASSOCIATE Annual Dues
For Report and Directory

Annual Membership .....$100.00

For those who support NPLC with an ad in the directory or
sponsorship of the annual meeting, Membership is complimentary

MEMBERSHIP NAME TO BE LISTED:

ADDRESS:


PHONE:   FAX:
E-MAIL:   WEB SITE:

PRIMARY CONTACT:
CONTACTS’S E-MAIL:

	Yes	No
Will you be sponsoring the annual meeting?
Will you be advertising in the Directory?
Sponsorship may be enclosed Amount=	$

DUE BY MARCH 1,

RETURN TO:

ZANE AKINS, TREASURER
177 PALERMO PLACE
THE VILLAGES, FL 32159-0094
TEL: 352-259-6005 FAX: 352-259-6005 (NOTE: IF YOU FAX YOU MUST CALL FIRST)