Membership Application
|
| The membership year begins on
September 1, but new memberships are accepted
at any time. Those who join later than March 1 should remit half
the
dues shown below. Please print this page, fill in the requested
information,
and mail the completed form with your dues to the Treasurer, Ken Drier,
64
Codjus Drive, Rising Sun, MD 21911. Please make checks payable to
the
Cecil Bird Club. |
Name(s)
|
__________________________________________________________________________
|
Address
|
__________________________________________________________________________ |
City
|
__________________________________________________________________________ |
State
|
___________________________
|
Zip
|
____________
|
|
Telephone
|
__________________________________________________________________________ |
E-mail
|
__________________________________________________________________________ |
|
|
May we publish the information
above in the CBC and MOS membership directory? (circle one)
|
Yes
|
No
|
|
New Member ____ or Renewal
____
|
Choose one of the following
categories and remit the dues as shown:
|
______
|
Individual
|
$25 (includes $20 for MOS)
|
| ______ |
Household
|
$35 (includes $30 for MOS) |
| ______ |
Sustaining
|
$65 (includes $50 for MOS) |
| ______ |
Junior
|
$10.00 (includes $5 for MOS)
|
| ______ |
Affiliate
|
$10 (for members of other MOS
chapters) Indicate other chapter_________________
|
| ______ |
Life
|
$1,100 (includes $1000 for
MOS, payable in 4 annual installments of $250 + $100 at time of
joining)
|
Thanks
for joining us!
|
