GRCHA

MEMBERSHIP APPLICATION

• NAME ________________________________________________
  
  
• ADDRESS _____________________________________________
  
  
• CITY ________________ STATE ______ ZIP _________________
  
  
• HOME PHONE __________________________________________
  
  
• E-MAIL ___________________________NRCHA #_____________
  
  
• APPLICATION FEE PAID _________________________________
  
  
• Club membership is due on an annual basis, due on January 1. (Any new membership received after Sept. 1 begins immediately but will be forwarded to the next year.)
  
  
• MEMBERSHIP DUES:
  
  
• $35 PER FAMILY
• $25 PER INDIVIDUAL
• $15 PER YOUTH
• $200 LIFETIME

Please make checks payable to GRCHA.
PLEASE PRINT THIS PAGE AND MAIL TO :

DAWN AVERA
213 RAYMOND AVERA LANE
EDISON, GA 39846
229-835-2825