Please print this page - If you do not have a printer, please copy the relevant
information on a sheet of paper and mail it to the address indicated below.

NAME _______________________________________________________________

ADDRESS ____________________________________________________________

CITY ______________________ PROVINCE / STATE _________________

COUNTRY ___________________ POSTAL CODE ______________________

RECOMMENDED BY - PATRICK GLASSFORD LM - 109

REGULAR (ANNUAL) MEMBERSHIP $25.00 U.S. __________

YOUTH (UNDER 18) MEMBERSHIP $7.50 U.S. __________
Please include date of birth __________________

LIFE MEMBERSHIP $400.00 U.S. __________
Available after one year of regular membership

FOREIGN POSTAGE (1ST CLASS MAIL) $12.50 U.S. __________
Must be added to all non U.S. addresses
to receive the ERRORSCOPE.

TOTAL ___________

Mail Application and Check, payable to CONECA in U.S. Funds, to:

Paul Funaiole
35 Leavitt Lane
Glenburn, ME 04401-1013
pfunny1@adelphia.net

Your membership is subject to approval by the Membership Committee and
subject to the rules and regulations set forth in the CONECA Constitution and Bylaws.