PLEASE HAVE YOUR MEMBERSHIP FORM PRINTED AND FILLED OUT BEFORE ENTERING AN EVENT. THEN FILL OUT AN ENTRY FORM FOR EACH EVENT AND BE SURE TO SIGN THE RELEASE AT THE BOTTOM.
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
easternbuckeyecrappieclub@yahoo.com OR WWW.CRAPPIE.COM OR WWW.EASTERNBUCKEYECRAPPIECLUB.COM