Membership Form

Printable Membership Form RICC MEMBERSHIP 2019 Membership form

 

(2019)  ROCK ISLAND CONSERVATION CLUB  (2019)

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: 

$75.00_______Extra Sticker: $5.00________ (1 Extra sicker allowed)

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

$60.00______           Extra Sticker: $5.00________ (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 $5.00. 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, 2019 – DEC 31, 2019

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