Name ______________________________________________________________________ Address ____________________________________________________________________ City ________________________________ State _____________ Zip _________________ County ________________________ Birthdate _______ Phone _______________________ E-Mail Address ______________________________________________________________ Occupation _________________________________________________________________ Check One Category:           ____ US Senior L:ife Membership (Age 70 and Older) $200 ____ US Life Membership (Under Age 70) $750 ____ US Life Membership (No Magazine)  $350 ____ US Life Membership Payment Plan (Lifetime member downpayment of $75 enclosed) then         _____ Bill Me $75 Per Month   or   _____Charge my Credit Card $75 Per Month ____ Check Payment Type:    ____ Check    ____ Money Order  ____VISA   ____ Discover                                        ____ Master Card    ____ American Express Credit Card Number ______________________________ Expiration _________________ Signature _________________________________________________________________

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NTA Lifetime Membership  Application