Text Box: Applicant Information

Text Box: WATERFOWL U.S.A.

Text Box: Northwest Indiana Chapter

Text Box: Membership Application

Text Box: Print out the application, complete the information and return with payment.

Text Box: Waterfowl U.S.A. Northwest Indiana Chapter 1707 South Cline Avenue Griffith, Indiana 46319    

Text Box: First Name

Text Box: Middle

Text Box: Last Name

Text Box: Current Street Address

Text Box: City

Text Box: State

Text Box: Zip Code

Text Box: Home Telephone

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Text Box: Cell Phone

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Text Box: E-Mail Address

Text Box: Please contact me VIA E-Mail about upcoming chapter events

Text Box: New Membership

Text Box: Renewing Membership

Text Box: Youth Membership ....................( $15.00 per year) Includes The Following: ·   A one Year Youth Membership to the Northwest Indiana Chapter of Waterfowl U.S.A. ·   1 entry in the special Youth Hunt Drawing, for waterfowl hunting at the Jerry Allen Marsh, Located in Boone Grove, Indiana  

Text Box: Regular Membership ....................( $25.00 per year) Includes The Following: ·   A 1 Year Membership to the Northwest Indiana Chapter of Waterfowl U.S.A. ·   Qualify to enter the " Members Only" hunt raffles.

Text Box: Executive Supporter  Membership .......( $275.00 per year)  Includes The Following: ·   A 1 Year Membership to the Northwest Indiana Chapter of        Waterfowl U.S.A. ·  Miniature Bouillet Decoy ·   Qualify to enter the " Members Only" hunt raffles. ·   Embroidered W.U.S.A. Sponsor Cap ·   Two Dinner Tickets ·   1 ticket for drawing of Executive Supporter's Shotgun ·   1/2 page advertisement in dinner program book  

 

Text Box: Please Choose From One Of The Membership Packages Below:

Text Box: Signature

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