Membership Form

Printable Membership Form ricc-membership-2017-membership-form
 
(2017)  ROCK ISLAND CONSERVATION CLUB  (2017)
MEMBERSHIP/RENEWAL APPLICATION   
(PRINT CLEARLY)MEMBER NAME (Printed on Membership Card)__________________________________________________I have read and acknowledge the rules of the RI Conservation Club and voluntary release all liability of the RICC.

SIGNATURE_______________________________________________DATE______________________

ADDRESS______________________________________________

TELEPHONE_____________________

 CITY______________________________         STATE___________       ZIP CODE__________________

GENERAL Membership: (Member, Legally Recognized Partner, Children under 18yrs), 1 Voting Right: 

$65.00_______Extra Sticker: $3.00________ (1 Extra sicker allowed)

SENIOR Membership: (Member 65 +, Legally Recognized Partner, Grand Children under 18yrs, 1 Voting Right:

$50.00______           Extra Sticker: $3.00________ (1 Extra sicker allowed)        TOTAL: $_________________

 You will receive one membership sticker with payment. (1) ONE additional car sticker can be purchased at a cost of $3.00. You must have the sticker affixed to your windshield directly behind the rear view mirror and your membership card must be in your possession when on Club property.            Memberships valid: JAN 1, 2017 – DEC 31, 2017

Circle the events that you would be willing to help out with.  Call me to help out with the following events:

Club Events___QCCA events___ Hunter Safety Clinics___ Call Me____   Blood Drive(Give/help)___

EMAIL ADDRESS: ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___

RETURN THIS FORM WITH CHECK OR MONEY ORDER TO:

RICC MEMBERSHIP CHAIR   P.O. BOX 3733 ROCK ISLAND, IL. 61204-3733