Membership Levels 

c  Life                                        $250

c  Household                              $15

c  Individual                                $12

c  Age 18 and Under                  $5

c  ECOC decal                            $1    each  X ____ quantity = $________     

      (Please enclose a self-addressed, stamped envelope for the delivery of your decals)

c  Additional Contribution $_________ to help support special ECOC events and speaker honoraria.

 
            Enclosed is a total of     $__________           

This is a   _____ new membership     ____ membership renewal. 

Please make checks payable to “E.C.O.C.”

Send payments to:  

Mary Donovan

42 Winthrop Ave.

Gloucester, MA  01930-2431 

or give them directly to Mary at a meeting. 

Name(s): _______________________________________________________________

 Address: _______________________________________________________________

                    _______________________________________________________________

 City, State & Zip: ________________________________________________________

 Phone: _________________________________________________________________

 Email address: __________________________________________________________

Use of email helps keep ECOC “green” and reduces our communication costs.  

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