Wild Ones   Wild Ones Ann Arbor Chapter -- Membership Application  

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Name: ______________________________________________________

Address: ___________________________________________________

City: ______________________________________________________

State: _____________________  Zip code: ____________________

Phone: _____________________________________________________

Email address: _____________________________________________

Chapter affiliation: Ann Arbor


PLEASE CHECK:   ____ new   ____ renewal   ____ new address

PAYING FOR:   ____ 1 year   ____ 2 years   _________ years
  Wild! Wilder!! Wildest!!!
Family membership $30 $50 $75+
Business membership $200 $500 $1,000+
Associate membership* $20    
* low income (full-time student, senior 65+, or disabled)

(ENTIRE MEMBERSHIP CONTRIBUTION IS TAX DEDUCTIBLE)

Amount enclosed ___________________

PLEASE SEND YOUR CHECK TO:
Karen Lowry, Treasurer
Wild Ones Ann Arbor Chapter
11606 Centennial Drive
Whitmore Lake, MI 48189-9755

return to Ann Arbor Chapter page




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Updated: Jun 12, 2005.
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