Last Name______________________________ First Name____________________________

Address_________________________________________________________________________

City____________________________________  State_________  Zip______________________

Home Phone___________________________  e-mail_____________________________________

Are you an IRA Member?    yes____     Number________________      no____

Position/Level_______________________________________________________________________

School__________________________________  School Phone_____________________________

Dues:     Local & AZ   $20.00     Student   $10.00     Retired   $10.00

Mail to:  Membership, 5441 E. Burns, Tucson, AZ  85711