Rats PacNW Membership Application Form

 

 

Name: 1)_________________________________________________

 

           2)___________________________________________________

 

           3)___________________________________________________

 

           4)___________________________________________________

        

           5)___________________________________________________

         

           6)___________________________________________________

 

Address: _________________________________________________

 

               ___________________________________________________

 

               ___________________________________________________

 

Phone: __________________________  Email: _____________________

 

 

Membership type:

 

 

___   $10.00 Individual Membership

 

 

___  $5.00 Junior Membership (12 and under - no voting privileges)

 

 

___  $17.50 - Family Membership - 13 and older (husband/wife, SO/SO, Parent/child, sibling/sibling);
             $5 for each additional household member over 12 years of age,

             $2 for 12 and under (please indicate which family members are 12 or under if any)

 

 

Total Membership Fees:  $____________

 

Please make check or money order payable to RatsPacNW and send form to:

RatsPacNW Membership Committee

8493 SE Spring Creek Road
Port Orchard, WA  98367