SCOA Associate Membership Application

( PLEASE PRINT LEGIBLY )

Please tell us about yourself:

NAME:

ADDRESS:

CITY:

STATE:

ZIP:

COUNTRY:

HOME PHONE:

WORK PHONE:

EMAIL:

1. When completed, send this application and your $20 membership fee to:

Robert Lyons
11 Netherwood Avenue
Piscataway, NJ 08854

732-457-8818 (evenings)
bob.sue.lyons@worldnet.att.net

NOTE: The SCOA does not have membership cards. The first response from the SCOA for most members will be receiving the quarterly issue of VENOM. The only exception is if merchandise or decals are ordered which will be shipped depending on availability.