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• Membership Levels 
• Life                                        $250
• Household                              $15
• Individual                                $12
• Age 18 and Under                  $5
• ECOC decal                            $1    each  X ____ quantity = $________     
• (Please enclose a self-addressed, stamped envelope for the delivery of your decals)
• Additional Contribution $_________ to help support special ECOC events and speaker honoraria.
• Enclosed is a total of     $__________           

This is a   _____ new membership     ____ membership renewal. 

Please make checks payable to “E.C.O.C.”

Send payments to:  

• Mary Stevens
• 67 Lake Drive
• S. Hamilton, MA 01982

or give them directly to Mary at a meeting. 

• Name(s): _______________________________________________________________
•  Address: _______________________________________________________________
•                  _______________________________________________________________
•  City, State & Zip: ________________________________________________________
•  Phone: _________________________________________________________________
•  Email address: __________________________________________________________

Use of email helps keep ECOC “green” and reduces our communication costs.  

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