Printer Friendly Form
To become a member, please print out the following application, fill in the
relevant information (as you would like it to appear in the directory), and
mail it to the address below. Membership questions can be sent to Rose Diaz. To pay by credit card, please go to Acteva and apply for membership.
Name__________________________________________________
Address_________________________________________________
City_____________________________State______
Zip_____________
Home Phone (___)___-________
Work Phone (___)___-________
Fax (___)___-________________
E-Mail Address____________________@________________________
Institutional
Affiliation_____________________________________
Membership Level (check one):
__ Individual $25
__ Student $15
__ Institution $50/100/150
__ Sponsor (individual) $50/100/150
__ Friendship $15
__ Lifetime $195
Please MAKE ALL CHECKS PAYABLE to SOHA
Send PAYMENT to :
Rose Diaz (rosediaz013@gmail.com)
3408 D Indian School Road NE
Albuquerque, NM 87106
505-255-6811 home/office
Please circle committees in which
you might be interested:
Newsletter Membership Annual Meeting Grants/Scholarships
Thank you for your interest in
SOHA!
