Hitaga Archery
MEMBERSHIP APPLICATION



CASH-CHECK-MONEY ORDER________________________ TOTAL AMOUNT  $___________


Name: _____________________________________        Date: _________________

Address: __________________________________        S. S. #____________________

City: ________________________   State: _____________  Zip: ________________




LIST ALL FAMILY MEMBER�S NAMES BELOW


(Add birth date if member is under 18 years of age)



     2nd Family Member    ________________________________Birth date_______

     3rd Family Member    ________________________________Birth date_______

     4th Family Member    ________________________________Birth date_______

     5th Family Member    ________________________________Birth date_______

     6th Family Member    ________________________________Birth date_______




MEMBERSHIP FEES


    Single Membership  --------------$20.00 
    Family --------------------------$25.00



Make check payable to the " Hitaga Archery "


                           MAIL TO:    
                                  Hitaga Archery Club
                                  C/O Gini Hayes
                                  4098 Jordans Grove Rd
                                  Central City Ia. 52214
Hosted by www.Geocities.ws

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