CA End of Life Option Act
Derek Humphry's List Serv
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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:
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.
Individual ______ $25 Couple ______ $40
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.
City: ___________________________ State: _____ Zip: ________________
Phone: ________________________ Email: __________________________
Comments (optional): _____________________________________________
Please mail form and check to the address listed near the top of this form.