Interested in Becoming a Member?

Please complete this form out and mail it, with your check or money order, to:
Self-Reliance, 23A Edgerton Drive, North Falmouth MA 02556-2821.

NEW MEMBER      MEMBERSHIP RENEWAL

Name(s) _____________________________________________________________________

Mail Address ___________________________ City __________________ ST____ Zip_______

Delivery Address __________________________City __________________ ST____ Zip_______

Phone Number(s) _________________________________e-mail: _______________________

I want the following member benefits (please check):

	heating oil co-op present oil co: _________________________________
	3.9¢/min. state-to-state long distance calling plan
	long term care insurance discount
	AUTOMOBILE ROAD ASSISTANCE/TRAVEL CLUB
	auto insurance discounts insurer: ___________________________________ agency: ___________________________________
	YANKEE magazine subscription discount
	E magazine subscription

Please send me more information about:

	Green Electricity
	Bio-heat
	Solar Electricity (PV)
	Solar Thermal (Heating & Domestic Hot Water)
	heating oil co-op
	3.9¢/min. state-to-state long distance calling plan
	long term care insurance discount
	AUTOMOBILE ROAD ASSISTANCE/TRAVEL CLUB
	auto insurance discounts
	YANKEE magazine subscription discount
	E magazine subscription
	other____________________________________________

YES, I’d volunteer for Self-Reliance. Please let me know about current projects.

Annual Membership Categories

	$30 household membership
	$15 senior (65 & over) household membership
	$40 non-profit organization
	$40 family membership (entitles young drivers in the family to the auto insurance discount)
	$50 business
	$15 MA Teachers Assn membership for oil coop

I want to support your work on behalf of renewable energy, energy efficiency and conservation.
Here is my additional, tax-deductible, contribution in the amount of:
$15    $30   $50   $100    other__________