Pomme de Terre Chapter Of MI Post Office Box #5 Hermitage, Mo. 65668
816-678-1623 George Donner Chapter President Email
Pomme de Terre Chapter Of Muskies, Inc. An Organization Dedicated To YOUTH FISHERIES RESEARCH Missouri Lakes With Muskies Lake Pomme de Terre, Fellows Lake, Henry Sever, Hazel Creek and Bush CA #35
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_____________
