DATE______________

NEW MEMBER______RENEWAL______

NAME________________________________________________________

ADDRESS_____________________________________________________

CITY________________________ STATE____________    ZIP CODE______

TELEPHONE: ____________________

DATE OF BIRTH:_________________

TEACHER:_______________________

SEND TO:     MEMBERSHIP DEPT.
  P.O. BOX 469
  NAPOLEON, OH 43545
 

_____REGULAR INDIVIDUAL MEMBERSHIP $18.00 PER YEAR

TEACHER’S MEMBERSHIP:
 _____REGISTERED: $18.00; _____LICENSED $22.00 PER YEAR

_____JUDGES MEMBERSHIP: $28.00 PER YEAR

_____CORPS/TEAM MEMBERSHIP: $24.00 PER YEAR

$______ AMOUNT PAYABLE TO W.T.A.:   _____CHECK;   _____ CASH
 
 

MONEY RECEIVED BY _____________________________ DATE_______