Potlatch 5 Membership Form


Memberships in Potlatch 5 are:

Supporting Memberships cost $15 at all times. A supporting membership gets you all convention publications and a warm fuzzy feeling.

Sunday Brunch is $13.25 including gratuity.

Please print out this form, fill it out, and mail it with your payment to:

Potlatch 5
c/o OSFCI
PO Box 5703
Portland, Oregon 97228-5703
Please make checks payable to "Potlatch 5".

List any additional names and addresses on the back or on a separate sheet.

I enclose $______ for ______ membership(s) and ______ brunch(es).

Name _____________________________________________________________

Address __________________________________________________________

City/State _______________________________________________________

ZIP/Postal Code __________________  Phone ________________________

E-Mail Address ___________________________________________________

Please tell us where you found out about this Web page:

__________________________________________________________________

Programming suggestions and comments:

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

Other information requested/comments:

__________________________________________________________________


Return to the Potlatch 5 Home Page