Pomme de Terre Chapter of Muskies, Inc.

Pomme de Terre Chapter Of MI
Post Office Box #5
Hermitage, Mo. 65668

816-678-1623
George Donner
Chapter President
Email

 

Annual Muskie Netting       

  Muskies Can Also Be
   Caught On Smaller Lures

Missouri Lakes With Muskies
        Lake Pomme de Terre, Fellows Lake, Henry Sever, Hazel Creek and Bush CA #35

Membership Form

 

Please Fill Out All Information

Please print this form, fill-in the appropriate spaces, then mail it with a check
or money order payable to: "MUSKIES, INC."
 
Click Here To Download A PDF Form

  Send To:
     Muskies, Inc.                          Phone Number  573-795-0052
Membership Chairman
C/O Tim Dunaway
602 E. Walnut
Shelbina, Mo. 63468
 

 

 

 

Name 

 

 

 

Address

 

 

 

City/State/Zip

 

 

 

Phone


Home                                                    

Cell             

 

 

Date Of Birth

Email Address

 

 

Chapter Affiliation Choice Number Pomme de Terre Chapter (05)

 

 

Check one: ___ New Member ___ Renewal ___ Address Change ___ Gift___

 

 

My Membership #_________________ Expiration Date_______________

 

  Please choose membership type:
Check appropriate box(s)
___ Regular Member 1 yr - $45.00 ___ Two yr - $75.00 ___ Three yr. - $105.00
___ Family -1 magazine 1 yr - $57.50 ___ Two yr. - $100.00 ___ Three yr. - $142.50
___ Junior Member (must be under 20 years of age) - $30.00
___ Regular Active Military Membership (must use APO/Military Installation address) - $40.00
___ Muskie Research Donation $____________
Name of Spouse_____________________________________
Name of Junior Member_______________ Birthday of Jr. Member_____________
Name of Junior Member_______________ Birthday of Jr. Member_____________
Name of Junior Member_______________ Birthday of Jr. Member_____________

Amount Enclosed____________________

 

 
     

Lets Go Muskie Fishing

Lets Go Muskie Fishing

Lets Go Muskie Fishing