LIVE FREE MEMBERSHIP APPLICATION AND PROGRAM REGISTRATION

NAME

DATE

ADDRESS

CITY

STATE

ZIPCODE

PHONE

New member []  Renewal [] 1 year $15.00 [] Life Membership $80 []

12 month newsletter subscription, discount suppliers list and special
publications list included with membership.

[] Pass my name on to my Regional Director and/or local Live Free
Affiliated Organization.
[] Add my name to the regional list for Operation Get Together so I can meet
other members.
[] Send me information on how my group can be affiliated with Live Free.
[] Send me additional flyers and membership applications.
[] Send me information on the Live Free Instructors Certification Program.
[] Send me information on the Live Free Shortwave Network.
[] Send me information on the Live Free computer network system.
[] I would like to be considered for future officership or staff positions,
my resume is enclosed.
[] Run the enclosed classified ad in the next ____ issues of DIRECTIONS at
$0.20 per word; $5.00 minimum. (every third ad is free)
[] Send me your display ad rates.
[] I am in a survival/self-reliance related business and will give a ________
discount on all [], some [] of the items I sell to Live Free members.

[] Send me______ green and______ white Live Free brassards at $2.50 each.

[] Send me_______Live Free T-shirts []S []M []L []XL at $6.50 each.

Enclosed is _______________ total.

LIVE FREE       11123 ST. LAWRENCE AVE.        CHICAGO,IL 60628

ExecuNet has no affiliation with Live Free.