Colorado Western Slope Grotto
Membership Application
Name: ___________________________________ NSS#: ____________
Address: _____________________________________________________
City: ______________________ State: ___________ Zip: __________
Telephone: (Home) __________________ (Other) _________________
Email Address: ________________________________________________
Emergency Contact: ____________________ Phone: ________________
Primary Grotto Affiliation: _______________________________________
Membership Categories: (Please circle one)
Full Member: (Must be an NSS member in good standing. Full Members have voting rights and are eligible to hold office)
Associate Member: (No NSS membership required. Associate Members may not vote or run for office)
Dues are $5.00 per year and are paid every December.
By signing this application, you agree to support the goals and conservation policies of the Colorado Western Slope Grotto, as stated in the Constitution and of this organization.
Signature: _________________________________ Date: ____________
Send to:
Tonya LeMoine
769 Cactus Ct.
Rifle Co. 81650
