Membership Form
Please print this form, fill-in the appropriate spaces, then mail with a check or money order payable to: "Midwest Musky Club."
Send to:
Midwest Musky Club
c/o Eddi Bock
7312 W. 110th Pl.
Worth, IL 60482
Name_____________________________________________________________________________________
Address___________________________________________________________________________________
City/State_________________________________________________ Zip Code _________________________
Phone_____________________________________________________________________________________
E-mail Address______________________________________________________________________________
Occupation_________________________________________________________________________________
Do you own a boat? YES______ NO__________
Were you sponsored by a current member? If so, who ______________________________________________
My Membership #_________________ Expiration Date_______________
Check one: ___ New Member ___ Renewal ___ Address Change ___ Gift
Please choose membership type:
Check appropriate box(s)
___ New Member 1 year - $40.00 (includes hat and can cooler)
___ Regular Member 1 year - $30.00
___ Additional Family Member each 1 year - $10.00 ___
___ Senior Member- $15.00
___ Muskie Research Donation $____________
Name of Spouse_____________________________________
Name of Family Member_______________
Name of Family Member_______________
Name of Family Member_______________
Name of Family Member_______________
Name of Family Member_______________