Eastern Buckeye Crappie Club

ANGLERS MUST PAY $20.00 ANNUAL MEMBERSHIP BEFORE FISHING

NAME______________________________________

ADDRESS_________________________________________

STATE_________________ZIP__________________

PHONE _______________EMAIL_________________________________

INDIVIDUAL_________$20.00 NEW MEMBER

_________$20.00 RENEWAL

SPOUSE_____________$10.00 PER YEAR, IF JOINING WITH SPOUSE

_________$10.00 RENEWAL

JUNIOR_____________$10.00 PER YEAR IF UNDER 16

________$10.00 RENEWAL

TOTAL______________

CHECKS PAYABLE TO; EASTERN BUCKEYE CRAPPIE CLUB

C/O TIM RICKEY, 16115 ST RT 258

TIPPECANOE, OHIO, 44699

OR CHARGE TO YOUR CREDIT CARD

NUMBER____________________

EXP. DATE MTH_____/YR______

ANY QUESTIONS CONTACT TIM RICKEY, 740-922-9661 WORK / 740-658-3782 HOME

To Bring Slab seekers of all ages together