(Form 0921, last revised Oct 2009) State Secretaries and others use this form to accompany materials dealing with member status. This file has fully active form fields. You will need Adobe Acrobat 4.0 or higher. The application fee will remain $60.00 until Jan 1, 2010. please make note. Note: Once filled in please print this form on canary yellow paper so it won't get lost in the documentation that it accompanies.