NOTE:  Any new paid memberships beginning October 1 are automatically enrolled for the full upcoming year. If joining in the middle of the year, prorate dues at 50¢/month single, or $1/month family.

Date:
_____ Self only ($6/year)	_____ Self & Family ($12/year)
Name
Street Address
City, State, Zip
Home Phone
Work Phone
Email address
Birth Date (Day, month only; for newsletter)
HOW DID YOU HEAR ABOUT ALL WEATHER WALKERS? (Please circle all that apply)
_____ Walking event	_____ Health fair
_____ Internet/online	_____ Newspaper
_____ Friend	_____ Other ________________