Membership Form
Please print this form, fill-in the appropriate spaces, then mail with a
check or money order payable to: "MUSKIES, INC."
Send to:
Muskies, Inc.
Ellen Wells
1509 Stahl Road
Sheboygan WI 53081
Name________________________________________________________
Address______________________________________________________
City/State___________________________________ Zip Code__________
Phone________________________________
Chapter Affiliation Choice Number –
Pomme de Terre Chapter (05)
My Membership #_________________ Expiration Date_______________
Check one: ___ New Member ___ Renewal ___ Address Change ___ Gift___
Please choose membership type:
Check appropriate box(s)
___ Regular Member 1 yr - $35.00 ___ Two yr - $65.00 ___ Three yr. - $95.00
___ Family -1 magazine 1 yr - $47.50 ___ Two yr. - $90.00 ___ Three yr. -
$132.50
___ Junior Member (must be under 20 years of age) - $20.00
___ Regular Active Military Membership (must use
APO/Military Installation
address) - $30.00
___ Muskie Research Donation $____________
Name of Spouse_____________________________________
Name of Junior Member_______________ Birthday of Jr. Member_____________
Name of Junior Member_______________ Birthday of Jr. Member_____________
Name of Junior
Member_______________ Birthday of Jr. Member_____________
Name of Junior Member_______________ Birthday of Jr. Member_____________
A PDF version of this application can also be found at:
www.muskiesinc.org |
