Membership Form

Please print this form, fill-in the appropriate spaces, then mail with a check or money order payable to: "MUSKIES, INC."

Send to:
Muskies, Inc.
Ron Groeschl
14257 Waters Edge Ter
New Berlin, WI 53151

Name________________________________________________________

Address______________________________________________________

City/State___________________________________zip code__________

Phone________________________________

Chapter Affiliation Choice Number - Central Ohio Chapter (41)

My Membership #_________________ Expiration Date_______________

Check one: ___ New Member ___ Renewal ___ Address Change ___ Gift

Please choose membership type:
Check appropriate box(s)

___ Family -1 magazine 1 yr - $47.50 ___ Two yr. - $90.00 ___ Three yr. - $132.50

___ Junior Member(to 18) - $20.00

___ Muskie Research Donation $____________

Name of Spouse_____________________________________

Name of Junior Member_______________Birthday of Jr. Member_____________

Name of Junior Member_______________Birthday of Jr. Member_____________