MEMBERSHIP APPLICATION (2012)

THE IZAAK WALTON LEAGUE OF AMERICA

Christiansburg-Montgomery Co. Chapter

YES! I WANT TO HELP SUPPORT THE CONSERVATION OF OUR NATURAL

RESOURCES. ENCLOSED ARE MY MEMBERSHIP DUES (for Calendar Year, not

prorated) WHICH INCLUDES A SUBSCRIPTION TO OUTDOOR AMERICAN

MAGAZINE.

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NAME E-MAIL PHONE

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STREET

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CITY STATE ZIP

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SPONSOR (Current Member) DATE

Dependent cards are available for a spouse, children (living at home under 18 years old),

and students living at home until age 21. A dependent card is required for children 16

and older.

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NAME Relationship to New Member

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NAME Relationship to New Member

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NAME Relationship to New Member

Make check for $135 payable to the Izaak Walton League ($110 dues + $25

initiation fee).

Applicant must be voted-in by club members at a chapter meeting

(1st or 3rd Thursday of each month, 7:30pm in the park clubhouse).

When completed, submit application and payment at a chapter meeting or mail to Janice

Austin, Membership Secretary at: 4495 Cumberland Drive, Christiansburg, VA 24073

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MEMBERSHIP DUES RECEIPT

Christiansburg-Montgomery Co. Chapter

 

NAME_____________________________________________
HAS PAID $135.00 FOR MEMBERSHIP DUES IN THE IZAAK WALTON LEAGUE, SUBJECT TO MEMBER APPROVAL. 

This receipt is good for 30 days.