Empire Orienteering Club Membership Application

________New Member ________Renewal


Join in:        Jan 1-Jun 30    Jul 1-Oct 31     Nov 1-Dec 31

Student*            $5              $5               $5
Individual (21+)   $15             $22              $15
Family/Couple      $20             $30              $20

Membership     Dec 31 of       Dec 31 of the    Dec 31 of the
 good until:   the same year   following year   following year

          *Student=college undergraduate or younger

Please print clearly

Name___________________________________________________________

Year Born________        M/F_____

Address________________________________________________________

       ________________________________________________________

City___________________________State______ZIP__________

Phone: Home______________________Work__________________________

E-Mail (use CAPS) _____________________________________________


If Family/Couple membership, list other members:

_________________________________________Yr Born______M/F______

_________________________________________Yr Born______M/F______

_________________________________________Yr Born______M/F______

_________________________________________Yr Born______M/F______


Is EMPO your primary club? Y/N___

Make checks payable and send to:
Empire Orienteering Club
P.O. Box 51
Clifton Park, NY  12065

rev. 1/2012