Print and mail this form:

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Dues are:

Single Annual...................$10.00 ($15.00 outside US)	Dual Annual..............$12.00 ($17.00 outside US)
Single Triennial..............$24.00 ($34.00 outside US)	Dual Triennial..........$30.00 ($40.00 outside US)
Single Life....................$150.00 ($174.00 outside US)	Dual Life................$175.00 ($215.00 outside US)
('Dual' is two persons at the same address.)
Separate Youth................$5.00 ($10.00 outside US)	Youth in addition to adult..$2.00

Name(s):______________________________________	Type of membership:___________
Address:______________________________________
City, State, Zip:_________________________________	Amount enclosed:_____________
E-mail address:__________________________

Make check payable to HIPS and mail to:

Membership Secretary, Judy Eckhoff
7911 S. Yoder Rd
Haven, Ks 67543-8114