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| Print out form, fill out and mail to: |
| WBGBA Membership |
| 17182 COUNTY HWY T |
| Tomah, WI 54660-6755 |
| or E-Mail BirdMo@Tomah.com |
| for more information |
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| Any person may become a WB&GBA member by sending a check for dues along with this membership form. "Family includes all persons living at the same address" Make check payable to: |
| WBGBA |
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| 1:First Name_______________Last Name________________________________ |
| { } I wish to renew my membership |
| { } I wish to become a new member (single). |
| { } I wish to become a new member (family). List other family members below. |
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| 3:If family membership |
| other family members:____________________________________________________________ |
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| ____________________________________________________________________ |
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| 4:Address ___________________________________________________________ |
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| 5:City_________________________________St.______Zip_______+4_________ |
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| 6:Phone_( )_______-____________County________________________ |
| 7:Business or |
| farm name (if any)________________________________________________ |
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| (One newsletter per address: 8: { } Renewal { } New 9:$________enclosed |
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| For______person(s) |
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| For______year(s) |
| Circle dues choice |
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| Since all MEMBERSHIP EXPIRE DEC.31, and the minimum dues is $15, new members joining between April 1 and Sept 30 may:1 )pay full year dues for part of a year or,2)pay prorated dues for the part year along with dues for following year. |
| see charts below: |
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| New Members 1Jan07 1Apr07 1Jun07 1Aug07 1Oct07 |
| Only Thru Thru Thru Thru Thru |
| No Renewals 31Dec07 31Dec08 31Dec08 31Dec08 31Dec08 |
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| New Member $15.00 $24.00 $21.00 $18.00 $15.00 |
| Single |
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| New Member $20.00 $29.00 $26.00 $23.00 $20.00 |
| Family |
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| * prorated amount includes remainder of year plus following year |
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| # no discount if for only part of a year (minimum dues - $15.00) |
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| Please circle dues choice for renewal |
| <OR> |
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| WBGBA USE ONLY |
| Do not write in this space |
| re__________________07 |
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| am____________i_____ |
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| cd___________________ |
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| dy___________________ |
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| #____________cm______ |
| ' |
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| ----------------------------One yr.-----Two yrs------ Three Yrs. |
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| Renewal-Single $15.00 $28.00 $41.00 |
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| Renewal-Family $20.00 $38.00 $56.00 |
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| * Oct 1st to Dec. 31st full rate includes remainder of year and next full year. |
| Jan. 1st to March 31st full rates apply. |
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| "THE BIRD & GAME PEN" |
| (official newsletter publication of the Wisconsin Bird & Game Breeders Association) |
| Send name and address to: |
| WBGBA Free Sample |
| 17182 CTH T |
| Tomah, WI. 54660-6755 |
| Or E-Mail: BirdMo@Tomah.com |
| A sample copy will be sent with the next newsletter mailing |
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| Note: Directory available - $5.00 |
| It lists members and stock information. |
| Mail check, name and address to: |
| WBGBA Directory Request |
| 17182 CTH T |
| Tomah, WI 54660-6755 |
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