Empire Orienteering Club Membership Application

________New Member ________Renewal


Join in        Jan 1-Jun 30    Jul 1-Oct 31     Nov 1-Dec 31
Student (<18)      $6              $9               $6
Individual         $10             $15              $10
Couple             $14             $21              $14
Family             $18             $27              $18
Membership      Dec 31 of      Dec 31 of the    Dec 31 of the
 good until    the same year   following year   following year


Name___________________________________________________________

Year Born________        M/F_____

Address________________________________________________________

       ________________________________________________________

City___________________________State______ZIP__________

Phone: Home______________________Work__________________________

E-Mail_________________________________________________________


If Family or 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

last updated: --Mon Aug 15 2005 10:40:17 AM EDT--