Check one: _____New _____Renewal

_____Family Membership (with Trapper) $20.00

_____Individual Membership (with Trapper) $18.00

_____Individual Membership (w/out Trapper) $10.00

_____Junior Membership--16 & under (w/ Trapper) $12.00

_____Junior Membership (w/out Trapper $6.00

_____Life Membership $200.00

___Installments of $25.00 per month

___Installments-$25.00 e/other month

Name: _________________________

Address: _______________________

City___________________________

State / Zip: _____________________

County of Residence: ______________

Telephone: ______________________

Birthdate: _______________________

Names & birthdates of other family members

(For Family Membership)

_______________________________

_______________________________

_______________________________

_______________________________