Please fill in the appropriate information, print form, and enclose $20 ($25 foreign) for a one year membership to the

Fairy Lamp Club & Newsletter

Make check payable to: James L. Sapp

Mail to:         Jim Sapp
                    P.O. Box 438
                    Pine, CO  80470-0438

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The following information may be included in the Fairy Lamp Club Directory. The membership directory will only be distributed to the Fairy Lamp Club members and will not be used for any other purpose or promotion.

Same as above.                Do not include me in the membership listing.

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I accept

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