Soule Kindred In America, Inc.
Membership Form

Please fill in this form and print it out. Please make your check payable to "Soule Kindred in America, Inc." and send the completed form along with your check to:

Betty-Jean Haner, Treasurer
53 New Shaker Road
Albany, NY 12205-3615

Please provide the following contact information:

Name:
Title:
Street Address:
Address (cont.):
City:
State:
Zip:
Country:
Phone Number:
E-mail:

Choose one of the following membership categories:

Life Membership $300.00
Patron Membership $ 75.00
Sustaining Membership $ 45.00
Regular Membership $ 25.00
Student (to age 22) $ 7.50