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Body  Recall Alliance Membership  Form

 I believe in the work of BODY RECALL and wish to join the BODY RECALL ALLIANCE in order to assist the projects and purposes of the organization.

 Enclosed please rind my donation of $___________for annual membership in the following category:

                   _____Member ($25)           _____Group ($500)

                   _____Sponsor ($100)         _____Eagle ($1000)

                   _____Patron ($250) .           _____Lifetime ($5000)

             Date____________                       _____New      _____Renewal

            Name____________________________________________________________

            Address_________________________________________Apt.#_____________

            City___________________State____Zip_________phone (____) - ____ - ______

 All friends who join the Alliance will be placed on our mailing list for one year and will receive our newsletters and publications.  We appreciate your support and belief in the program.

               Membership and/or charitable gifts may be mailed to:            

                   BODY RECALL, INC.      P.O. Box 412       Berea, KY 40403

BODY RECALL, INC is tax-exempt under Section 501 (C) (3) of the Internal Revenue Code.