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Annual Membership Dues:  $20

Please send a check or money order with the requested information below payable to:

    SD Coalition for Shared Parenting
    Steve Mathis, Chair
    501 Douglas Ave
    Yankton, SD 57078

Please begin a membership for me in The South Dakota Coalition for Shared Parenting. Please find enclosed my remittance of $20.00.

Name _________________________________________________

Address _______________________________________________

City ___________________ State _______ Zip ________-_____

Home phone number (______) __________

Work phone number (______) __________

Fax number (_______) ___________

Email address _________________________