Missouri Waterfowl Association - Membership Application

Membership Information:
First Name:	______________________________	Last Name:	______________________________
Address:	____________________________________________________________
City:	______________________________________	State:	______________________
Zip Code:	______________________	Country:	______________________
Phone	(_____) _____________________	Email:	______________________________

Yearly Membership Fiscal Year - October 1st - September 30th
New Members Only:
Oct. 1st - Mar. 31st (Full Membership Price)
Apr. 1st - Sept. 30th (1/2 Membership Price) w/ Full Membership Renewal due on October 1st.
Renewal dues are due on October 1st of each year
Renewals are Full Membership Price no matter date sent in

Please check one:

New Member

Renewal

If you are a new member, please check one of the following:

Sprig Membership (under 16) $10.00	(Sticker, Newsletter)
Regular Membership $25.00	(Sticker, Newsletter)
Life Membership $300.00	(Sticker, Newsletter, Cedar Wood Duck Box)
Corporate Sponsor - $75.00	(4 Business Card Ads in Newsletter)
Gold Corporate Sponsor Bronze Status - $250.00	(4 - ¼ page Ads in Newsletter, Certificate)
Platinum Corporate Sponsor Silver Status - $500.00	(Decoy, 4 - ¼ page Ads in Newsletter, Cedar Wood Duck Box)

The Missouri Waterfowl Association is a Tax Exempt 501(c) 4 corporation.
Make checks payable to "Missouri Waterfowl Association"
Please complete this form, include the appropriate amount and mail to:

Missouri Waterfowl Association
P.O. Box 656
Columbia, MO 65205-0656

© 2006 Missouri Waterfowl Association. All rights reserved.