Individual: $30.00 ($35.00 if you need newsletter, etc. mailed) Additional Family Member(s): $ 10.00 (for each member at same mailing address)

Please fill a separate form for each new household member. (This contribution is not deductible as a charitable contribution for the Federal income tax purposes.)

Member = _x $10.00 _x $ _ 30.00 TOTAL __

Please make your check payable to Desert Sharks PHC and send check to:

Donn Mouw

Membership Chair

38105 S Elbow Bend Dr.

Tucson, AZ 85739

Any questions you can call at 925-708-0638