Name:
County or Location:
Email address:
Check will be sent from:
▢ Personal
▢ County
▢ State
▢ Other
Please check dues your are paying:
▢ ESP Dues (Returning Member): $95.00
▢ ESP Dues (New Member): $85.00
▢ Life Member Dues (for Retirees) $275.00
Total paid:
Additional notes:
Important information
Make checks payable to:
Epsilon Sigma Phi – Zeta Chapter
Send payment and copy of printed invoice to:
Dolores County Extension
Attn: Gus Westerman
P.O. Box 527
Dove Creek, CO 81324