MEMBER'S COPY 
GROUP HEALTH ASSOHATION, INC 
EX ecutive 3-8000 
1025 Vermont Avenue^ N. W. 
WASHINGTON 5, D. C. 
RECEIVED OF 
MEMBERSHIP 
NO 
DATE. 
19 
^ S' 
AMOUNT 
RECEIVED 
DOLLARS 
£>0 
CENTS 
' V 
w 
DRAFT 
M. O. 
CHECK 
CASH 
A 
-V ■■ 
FOR 
OPTICAL 
DENTAL 
ON ACCT. 
MISC. 
THANK YOU 
64604 
REC'D BY 
V. UARCa \HQ.f DEEPRiVERf CONN. 
