SEMBA MEMBERSHIP APPLICATION
(Effective January 1, 2016)
Print, complete and mail.


   
                                                  Date_______________


    Name:  ___________________________________ 

    Address:  ________________________________ 

    __________________________  Zip:  _________ 

    Telephone:  (      )_______________ 

    E-Mail Address:  __________________________ 

    

    Dues for those who elect to receive the SEMBA Newsletter by Email:

         SEMBA (Individual):  $10.00_____ 
              or
         SEMBA (Family):      $15.00_____ 
    
    
    

    MAKE CHECKS PAYABLE TO SEMBA 
    
    SEND TO:   SEMBA
               218 S. Main St. Suite E 
               Plymouth, MI  48170