Please provide the following contact information:

Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Work Phone
Home Phone
E-mail

What level of Friendship would you like to select?

FILH, FILOS - FRIEND ($50)            

Student / Senior Citizen ($25)

DWRHTES - DONORS ($100)

CORHGOI - PATRONS ($250)

EUERGETES - BENEFACTORS ($500)

MEGALOI EUERGETES - GREAT BENEFACTORS ($1,000)

Please note:  no money is due at this time.  Upon submission of this form, we will contact you to discuss payment options.