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 |
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