Official SCOPE Membership/Donor E-Form


Please fill in the form below. You will be sent a bill for membership (alas, we don't yet have online payment methods) and when the check clears you will be a member. If a donation, we'll bill you for your pledge.


 Donation Information


Do you want to be a member, a donor, or both?

Donation type:



Option 1 - If you want to be a member, please fill out the following:


Regular Single Membership ($25/y)

Regular Family Membership ($35/y)


Option 2 - If you want to be a donor, please fill out the following:









(Other amount)

Value of pledge; omit the dollar sign ($).


Option 3 - If you want to do both, fill out both of the above


 Personal Information


Please fill out the following. Items marked with an asterisk (*) are optional.

If this is a family donation, you can use "The Smith Family" in Last Name, or "John and Martha" in First Name (latter is preferred)

If you are making a donation for an organization, enter the organization's name in Last Name.


Prefix (Mr. Mrs. Etc)*



First Name



Middle Name



Last Name


Suffix (Sr. Jr. Etc)*



Street Address











Zip/Postal Code



Home Phone *



Work Phone *



Fax Phone *



Mobile Phone *



Pager Phone *



E-mail *


Useful skills for SCOPE *




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