FLY FISHERS FOR CONSERVATION

 2021 FFFC MEMBERSHIP APPLICATION

NAME(s): Please list names as you want them to appear on Membership Badge

1. __________________________________   Primary Member

2. __________________________________   Spouse

3. __________________________________   Relationship ___________________

4. __________________________________   Relationship ___________________

Note: Membership badges will be retained and distributed at club meetings.

Retired: Yes ____ No ____ If No, please List Occupation _________________________

NEW MEMBER Yes ____ No ____

ADDRESS: _______________________________________________________________

CITY: _____________________ STATE: ________       ZIP: _______________________

PHONE: ________________________ E-MAIL: _________________________________

Please note that all contact information above must be completed

Family (2 or more) ……….………………….….. $25.00             __________

(Can include partner & children under 18 years old)

Adult (18 to 64 years) …………………………… $20.00             __________

Senior Membership (65 years +) ………………. $15.00             __________

(Can include partner)

Junior Membership (under 18 years) … ………. $10.00              __________

Life Membership (Can include partner) ………. $500.00            __________

Additional Conservation Donation (Optional)……….                 __________

Total Due……………………………………………….             __________

 Payment can be processed at club meetings or mail the completed form, along with a check, payable to:

FFFC (Fly Fishers for Conservation)

PO Box 1192

Clovis, CA 93613