MEMBERSHIP FORM Please print out this form and send (with check or money order), payable to:

Contact Name:
Mail Address:
Day Phones:
Night Phones:
Current eMail:

Keep my name private. Do not include my name in the TIMOTCA's Peace Registry. I decline member benefits as a GIFT GIVER. Other Amount: I would like a fully tax-deductable receipt for my contribution.

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