APPLICATION FOR MEMBERSHIP
NAME__________________________________________________________________________________
ADDRESS_______________________________________________________________________________
CITY___________________________ ZIP_______________________
STATE___________ PHONE ( )___________
DOB___/___/___ OCCUPATION______________
E-MAIL______________________ MEMBERSHIP TYPE_________
NRA member: yes___ no ____
SIGNATURE__________________________________
Will you accept the news letter via E-mail? Yes___ No____
Recommending Member (print and sign) ___________________________________________________
Initiation Fee(all but juniors) $35.00
Regular Membership $75.00 TOTAL DUE _________________
Family Membership $150.00
(Family = Father, Mother & children under 18)
Junior Membership $15.00 Have you been convicted of a
Senior Membership (55 and older) $50.00 Felony ____yes ______no
subject to background check
print this form -- fill it out and return it to Perch Point with a check for the correct amount.
Perch Point Conservation Club
P.O. Box 230068
Fair Haven MI 48023
Questions call Cliff at 810-531-1765 or e-mail cliffjahn@msn.com
NAME__________________________________________________________________________________
ADDRESS_______________________________________________________________________________
CITY___________________________ ZIP_______________________
STATE___________ PHONE ( )___________
DOB___/___/___ OCCUPATION______________
E-MAIL______________________ MEMBERSHIP TYPE_________
NRA member: yes___ no ____
SIGNATURE__________________________________
Will you accept the news letter via E-mail? Yes___ No____
Recommending Member (print and sign) ___________________________________________________
Initiation Fee(all but juniors) $35.00
Regular Membership $75.00 TOTAL DUE _________________
Family Membership $150.00
(Family = Father, Mother & children under 18)
Junior Membership $15.00 Have you been convicted of a
Senior Membership (55 and older) $50.00 Felony ____yes ______no
subject to background check
print this form -- fill it out and return it to Perch Point with a check for the correct amount.
Perch Point Conservation Club
P.O. Box 230068
Fair Haven MI 48023
Questions call Cliff at 810-531-1765 or e-mail cliffjahn@msn.com