and mail to “KDFGA Box 164 Kamloops B.C. V2C 5K6”
Surname _______________________ Name________________ Today’s date______________
Age_________
Circle one : Regular ($50)
Family ($60 - incl spouse and/or kids 18 and under)
Junior ($10 - age18 and under)
partner’s name ____________________
Kids (18 and under) names (age)____________ (___) _____________(___) ____________ (___)
Amount paid_____________
COMPLETE REST ONLY if NEW or CHANGED:
email ___________________________________________
Mailing address _____________________________________________________________
City_________________________ Postal Code ______________ Phone _____________________
Office use only :
membership by ________ card by ________ dues by _______ date ______________
Rev Dec 10 10