Izaak Walton League of America, Inc.
Frederick Chapter, #1
Frederick, Maryland

Application for Membership
Please print

 

Name:________________________________________    Date:__________________________

Address:_______________________________________  Home Phone____________________

City:__________________________________________  Work Phone_____________________

State________________________ Zip________ Occupation____________________________

Dues:                 Regular (National, State, Chapter) ____________$45.00
                          Family                                            ____________$67.50
                          Student                                           ____________$10.00
                          Life (National)                                ____________$350.00

Sponser:___________________________________________________

Please check the Committees in which you are interested:
Ranges: _______                                                           Fishing: _______
Conversation: _______                                                 Public Relations: _______
Legislative: _______                                                     Ways & Means: _______
Program: _______                                                         Food: _______
Nature Area: _______                                                   Awards: _______
Save Our Streams: _______                                          Other – Specify: _______

Your check should be payable to: Frederick Chapter #1, IWLA

Mail Application to:

Charles I Wiles, Membership Sec
16021 Comus Road
Clarksburg, MD 21871