Join us North Platte Walleyes Unlimited Membership Application Form Annual membership fees in North Platte Walleyes Unlimited are $25.00 for a single or $30.00 for a family membership. Is this application for a (New Membership____) or a (Renewed Membership____)? (Please place an "X" in the appropriate space above) Is this application for a (Single Membership____) or a (Family Membership____)? (Please place an "X" in the appropriate space above) If Family Membership, please indicate number of persons in your immediate family_____ Name: ___________________________________________________________________ (Include spouses name if this is for a family membership) Street or P.O. Box #: _______________________________________________________ City, State, Zip Code: ______________________________________________________ Phone #: ________________________ E-mail address:_____________________________________________ May we publish your name and phone number in a membership directory accessible by all members? (yes_______) or (no_______) (Please place an "X" in the appropriate space above) Applicant's Signature and Date: ______________________________________________ Note: A membership year runs from March to March of the following year, however, membership fees can be pro-rated for new members. Please print out this form, and include the appropriate fee making checks payable to North Platte Walleyes Unlimited. Then mail the form and fee to: P.O. Box 1363 Casper, WY 82602 |
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