the Hemlock Society of San Diego

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We are an
all-volunteer organization.
No funds go to salaries.

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Join or Renew your Membership
in the Hemlock Society of San Diego


Application for Membership by sending a check
We hope you will join Hemlock Society of San Diego. If you would like to pay for membership electronically via PayPal, please go to this page:

Please print this page (click FILE-PRINT) and send it with your check made out to HSSD to the following address:
      HSSD
      PO Box 34237
      San Diego, CA 92163


Application for Membership
Hemlock Society of San Diego

A non-profit tax-exempt 501 (c)(3) independent organization
Tax ID #: 33-0467982
Donations and memberships are tax deductible.

Enclosed is my check to be a Member of the Hemlock Society of San Diego.

Choose one:


 
    1-year membership

        Individual ______ $25         Couple ______ $40

    Life membership

        Individual ______ $250       Couple ______ $400



____ I would also like to support HSSD with an additional donation of $_________.

____ I may be interested in including HSSD in my Will or Trust. Please contact me to discuss this further.


Name(s): _______________________________________________________


Title(s): ________________________________________________________


Address: _______________________________________________________


City: ___________________________  State: _____  Zip: ________________


Phone: ________________________  Email: __________________________


Comments (optional): _____________________________________________


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Please mail form and check to the address listed near the top of this form.




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