WSPA
5119 136th ST SW
Edmonds, WA 98026

Name: ___________________________________________________

Address: _________________________________________________

City: _____________________________________________________

State: ____________ Zip: ___________________

Airplane: N#: _______________Type: ________________________________

Bus: ________________________Home: ___________________________

Email address is neccessary for communications

_______________________________________________________________

________Memberships @ $25 ea =                                     $ ______________ 

Open Water Legal Fund Donation:                                         $ _______________

                          TOTAL:                                                         $ ________________