Membership Registration

Please print this form and mail with check or money order to: DPLS P.O. Box 827 Dana Point, CA 92629 Make Checks Payable to DPLS. Dues, Gifts & Donations may be tax deductible (see your accountant)

Membership Application Name: _______________________________________________ Phone: _______________________________________________ Address: _______________________________________________ City: _________________________ State:  ____ Zip: _____________ Email: _______________________________________________ Fax: _______________________________________________ Referred By: _______________________________________________