Join Us!
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
- Titletown Muskies Inc. Chapter Number
4
My Membership #_________________
Expiration Date_______________
Check one: ___ New Member ___ Renewal ___ Address Change ___ Gift
email address____________________________________
Please choose membership type:
Check appropriate box(s)
___ Regular Member 1 yr - $35.00 ___
Two yr - $65.00 ___ Three yr. - $95.00
___ Family -1 magazine 1 yr - $47.50
___ Two yr. - $90.00 ___ Three yr. - $132.50
___ Junior Member(must be under 18
years of age) - $20.00
___ Regular Active Military
Membership (must use APO/Military Installation address) - $30.00
___ Muskie Research Donation
$____________
Name of
Spouse_____________________________________
Name of Junior
Member_______________Birthday of Jr. Member_____________
Name of Junior
Member_______________Birthday of Jr. Member_____________
A pdf version of this application
can be found at: www.muskiesinc.org