SRA Membership CHANGE Form

Name: _______________________ Phone: (____) ________________

Address: ______________________ E-Mail: ______________________

City: ______________ Province: ___________ Postal Code: _________

Place a check mark þ in the appropriate box:

⃞ Change of Membership information (address, phone, etc.)

⃞ Contribution to the Legal Fund: $ __________

⃞ Renewing Membership: ________ X $ 10. = $ __________

(# years – max. 5)

⃞ Total Amount submitted $ __________