S.T.O.R.M. Membership Application

S.T.O.R.M.
P.O. Box 52
Parchment, Michigan 49004-0052
www.mistorm.com

Name:__________________________________________________
Home Address:___________________________________________
City: ___________________ State: _________ Zip: ____________

Agency/Organization: ______________________________________
Address:_________________________________________________
City: ___________________ State: _________ Zip: ____________
Telephone: (W) _____________________ Fax: ________________

(H) __________________________ Email:________________
Date Certified in Standardized Field Sobriety Testing: ____________

MEMBERSHIP FEE: TYPE OF MEMBERSHIP

S.F.S.T. Certified Officers ...................... $20.00 per year
Associate ............................................. $25.00 per year

SUBMIT PAYMENT BY CHECK OR MONEY ORDER ONLY New Application
Renewal (May 1st to April 30th)
Charter
Active
Life Active
Honorary

Membership #: ________________

Make check or money orders payable to: S.T.O.R.M.
Mail Membership Form and Payment to:
S.T.O.R.M.
P.O. Box 52
Parchment, MI 49004

Funded by: Office of Highway Safety Planning Project MI S.T.O.R.M. PT-99-27

MEMBERSHIP FEE:	TYPE OF MEMBERSHIP
S.F.S.T. Certified Officers ...................... $20.00 per year Associate ............................................. $25.00 per year SUBMIT PAYMENT BY CHECK OR MONEY ORDER ONLY	New Application Renewal (May 1st to April 30th) Charter Active Life Active Honorary
Membership #: ________________ Make check or money orders payable to: S.T.O.R.M. Mail Membership Form and Payment to: S.T.O.R.M. P.O. Box 52 Parchment, MI 49004 Funded by: Office of Highway Safety Planning Project MI S.T.O.R.M. PT-99-27