East Coast Allred Family Association, Inc.
Membership Application

Please print clearly.

Name: _________________________________________

Address: _______________________________________


Phone: ________________________________________

E-mail: ________________________________________

(Please list e-mail if you have it because this is how most of our correspondence is sent.)

Memberships:  (Please check appropriate box.)

___ Individual $15.00 per year

___ Couple (husband and wife) 25.00 per year.

Spouse’s name: ______________________________

Make checks payable to:  East Coast Allreds

Mail checks to Harlan Sexton 886 Westmont Dr. Asheboro, NC 27205-4262

*Tax-deductible donations are gladly accepted to promote the non-profit activities of this 501(c)(3) organization.

For ECAFA Use Only

Date Received:___________

Check No.:____________           Amount:_________

Cash:________________         Amount:_________

Membership Year:_______