Rio Grande Valley Rocket Club
(Membership application)
Date______________
I_______________________________make application for membership to the Rio
Grande Valley Rocket Club.
Address__________________________________________________________
City__________________________State_________Zip._____________
E-Mail Address____________________________________________________
Web Page Address________________________________________________
Date Of Birth___/___/______ Phone Number (____) ____-_______
Membership Level, Adult: $15.00 Yr. (___) Junior: $7.50 Yr.(___) (ages 3 thru 17)
Member of N.A.R. Yes (__) No (__) if yes, Insured Yes (__) No. (__)
N.A.R. Number ______________ Expiration __/__Certification Level_____
Member of Tripoli? Yes (___) No (___)
Tripoli Number _____________ Expiration __/__ Certification Level____
Do you want your address and e-mail address published in the roster? Yes (__)No (__)
Signed __________________________
Please mail completed form and check or money order to:
Rio Grande Valley Rocket Club
C/O Louis Van Doren
4506 N. Bus 77 #93
Harlingen, Texas 78552
(956)364-2259
For More information contact:
Randy Ashley
Rt 1 Box 328
Raymondville, Texas. 78580
(956) 248- 5268