One Year @ $20.00                                 $__________________

Three Years @ $50.00                             $__________________

Life Member (select payment from           

       Table below)

    Age 49 and under $250.00                   $__________________

    Age 50-55           $225.00                   $__________________

    Age 56-60           $200.00                   $__________________

    Age 61-65           $175.00                   $__________________

    Age 66 and over   $150.00                   $__________________

                                 TOTAL                  $__________________

 NAME______________________________________________

ADDRESS___________________________________________

CITY_______________________STATE_________ZIP________

PHONE______________________________________________

 Do you currently receive THE VETERAN in your household? __Yes __no

METHOD OF PAYMENT:

__________Check           

__________Money Order

__________Visa             

__________MasterCard

__________Optional payment plan down and $25.00 monthly with coupon

Sharon Beck Knowles

6886 US HWY 72W
Athens, AL  35611-8864
(256) 729-8150