Date ___________________________________________           (          ) Annual Membership   $25         

  Name(s) ________________________________________            (          ) Three-year Membership   $65                       

  Address ________________________________________            (          ) Lifetime Membership   $300         

  City ____________________ State _____  Zip _________              (          ) Libraries and Organizations:      
                                                                                                                                           1-yr subscription to Cornsilk   $25

  Phone   (                ) _______________________________                           

  E-mail _________________________________________                   Amount Enclosed                  $__________

 I would Consider: 
    Officer:  Yes _____  No ______

    Committee type: ________________________________