Membership Information/Activities
Web Site: http://www.grsm.org    Phone: 804-353-7040
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MEMBERSHIP APPLICATION
For the period January 1, 2007 through December 31, 2007

_____________________________________
Title           Name

_____________________________________
Address

_____________________________________
City, State, Zip

_____________________________________
Phone           Email Address

Licensed Minister___ Ordained___
Licensed Practitioner___ Other___

Licensed by:_________________________

All members receive the newsletter and mailings; licensed professionals are listed in publications and on the Web site and participate in professional events.

Annual dues (payable by check or M.O.):
Professional: Minister $75.00
Practitioner: $50.00
Associate: $25.00

New memberships after July 1 are prorated at 50% of annual dues.

MAIL TO:
GRSM
4625 W. Broad Street
Richmond, VA 23230