Application/Renewal for Membership

Name ___________________________________________

Company Name ___________________________________

Address  _________________________________________

City ______________     State  ________   Zip   _________

Tel ____________________        FAX  _________________

E-mail   ______________________________

 New Member?  Yes/No

Renewal?          Yes/No

 Please complete this membership form and send along with a check payable to : E.S.H.P.A. in the amount of $20.00 to:

Hans Junga

46527 CO Rte 1

Alexandria Bay, NY 13607