Tiffin Seneca County Izaak Walton League of America

Application for Membership

I hereby request membership in the TIFFIN SENECA COUNTY IZAAK WALTON LEAGUE OF AMERICA, Club # 37- 170. I am an American Citizen of good moral character. If accepted for membership, I will abide by ALL bylaws and rules governing members of the TIFFIN SENECA COUNTY IZAAK WALTON LEAGUE OF AMERICA.  Additionally, I will follow all Local, State, and Federal Laws while on Club grounds or representing the Tiffin Seneca Izaak Walton League of America.

APPLICANT'S NAME______________________________Contact Phone #_______________

ADDRESS___________________________________________________________________

E-MAIL ADDRESS: _______________________________@___________________________

SIGNATURE________________________________ License Plate ______________________

In Case of Emergency Call: Name___________________________________________Phone_______________________

NRA MEMBER (Yes or No) ___________CARD NUMBER________________________

OTHER CLUB MEMBERSHIPS___________________________________________________

INTERESTS: Rifle_______ Pistol_____ Collecting_____ Hunting__________ Trap _______ Target & Competition_______ Plinking________ Fishing _____ Archery_________.

Antique or Historical military weapons __________ Ecology –Conservation_______________

Other Interest: ________________________________________________________________

What Activities would you like to help with? ________________________________________________________________________________________________________________________________________________________One Time Initiation Fee: $50.00 Annual Dues: $105.00 (Individual member) Youth member” 18.00 (age 17 and younger) Student member 45.00 (full time students) Family Dues: $130.00 Family Member Names: ______________________________________________________

A family Membership shall include one or two adults over the age of 18 years of age and their natural, adopted or foster children under the age of 16 years of age RESIDING together at a single residence. Each Family Membership shall be counted as two members on the National IWLA rolls.

For family memberships, please list names and birthdates for children: ________________________________________________________________________________________________________________________________________________________________________

Use <CTRL> + <P> to print the application (Hold down the “CTRL” while pressing “P”

Membership Application please send to: Attn Brian,
P.O. Box 724 Tiffin, Ohio 44883