Membership

Fort Wayne Chapter

Izaak Walton League of America

Membership

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THE IZAAK WALTON LEAGUE OF AMERICA

MEMBERSHIP APPLICATION

BUILDING A BETTER OUTDOOR AMERICA

PLEASE PRINT AND FILL IN COMPLETELY THANK YOU

AMOUNT ENCLOSED_________________ DATE__________________

NAME:_________________________________________________________________

ADDRESS:______________________________________________________________

CITY:__________________________________________ ZIP:___________________

Phone No.(s)____________________________________________________________

OCCUPATION:___________________________________________________________

MY INTEREST(S):________________________________________________________

ANNUAL DUES:

REGULAR MEMBER (age 22 & over)................... $80

FAMILY (incl. wife & minor children)............... $115

STUDENT (age 18 to 21)................................. $65

SENIOR (age 65 & retired).............................. $65

ADDITIONAL FOR RIFLE, PISTOL, ARCHERY RANGE PRIVELEGES $25 FOR FAMILY OR INDIVIDUAL

CHECKS PAYABLE TO “FORT WAYNE CHAPTER, IWLA”

SEND TO MEMBERSHIP DIRECTOR

17100 GRIFFIN ROAD

HUNTERTOWN, IN 46748

260-637-6735

CHAPTER ADDRESS

17100 GRIFFIN ROAD

HUNTERTOWN, IN 46748

260-637-6735

EVERY PERSON WHO COMES ON THE RANGE TO SHOOT OR OBSERVE MUST TAKE A RANGE SAFETY COURSE WITH ONE OF OUR RANGE OFFICERS.

SPONSOR’S NAME:_________________________________________________________________

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