(Print application and mail to: AAGS, Inc., PO Box 7385, Freeport, NY 11520-0757) 

Membership Annual Dues: $25 Individual $35 Family  

Your Name:_______________________________________________________________

Street Address:_____________________________________________________________

Town/State/Zip____________________________________________________________

Phone # (day)_____________________________________________________________

Phone # (eve)_____________________________________________________________

Select of the following Chapters:     
AAGS @ Central Alabama-Montgomery, AL           [ ]
AAGS @ Freeport, NY                                            [ ]
AAGS @ Macon Library-Bedford Stuyvesant, NY     [ ]

To pay by credit card, circle the card you are using:

                   MC   VISA    Am Ex    Discover

Card Number:_____________________________________________________________

Exp. Date: ________________   3-or 4-digit ID Code_________

Card Holder’s Name (print):__________________________________________________

Card Holder’s Signature: ____________________________________________________

Or, send a check or money order payable to “AAGS, Inc.” to:
AAGS, Inc., P.O. Box 7385, Freeport, NY 11520-0757