LAKE HURON FISHING CLUB
        MEMBERSHIP APPLICATION
        P.O.BOX 355, SOUTHAMPTON, ONT., N0H 2L0

	RENEWAL:____	NEW:___	

	LAST NAME:___________________________	  FIRST NAME: _________________________
	
        ADDRESS:___________________________	  TOWN:	_______________________________
	
        POSTAL CODE: ___________________________  PHONE:_______________________________
	
        AGE:___________________________	          OCCUPATION:__________________________
	
        DO YOU WISH TO RECEIVE YOUR NEWSLETTER BY EMAIL:   YES  0      NO 0
        
        E-MAIL ADDRESS: _________________________	

  
  TYPE OF MEMBERSHIP

  JUNIOR (under 18 yrs.) 	1 yr. $10.00 	 with OFAH   $30.75		
  ADULT      ----------------	1 YR. $30.00	 with OFAH   $60.75		
  ADULT      ----------------	3 YR. $75.00 	 with OFAH   $167.25		
  FAMILY      ---------------	1 YR. $35.00	 with OFAH   $76.75		
  FAMILY      ---------------	3 YR. $90.00	 with OFAH   $215.25		
       
  CORPORATE ------------------  1 YR. $35.00    		
  CORPORATE ------------------  3 YR. $90.00   	 OFAH NUMBER _____________
  
INFORMATION FOR FAMILY MEMBERSHIPS

  NAME OF SPOUSE:    		______________________________________		

  DEPENDENT CHILDREN:		______________________________________		AGE:	____________ 
		 		
                            ______________________________________		AGE:	____________ 
							
                            ______________________________________		AGE:	____________ 
							
                            ______________________________________		AGE:	____________ 

 		
  WE WOULD LIKE TO HAVE YOUR COMMENTS.
  WRITE THEM OUT ON A SEPARATE SHEET AND ATTACH TO THIS FORM.	

  CLUB INVOLVEMENT

  I WISH TO BE A SUPPORTING MEMBER ONLY. PLEASE DON'T CALL ___	
		
  I WISH TO HELP IN THE FOLLOWING AREAS:	

    	DERBY WEIGH STATION ___	    		DERBY COMMITTEE	 ___	
    	STREAM ENHANCEMENT  ___	    		COMPUTER WORK	 ___	
	    TROUT HATCHERY	    ___ 		    KINCARDINE DOCKS ___			
	    SALMON HATCHERY		___	            WHEREVER NEEDED	 ___	

 PLEASE MAKE CHEQUE PAYABLE TO "LAKE HURON FISHING CLUB"
		
 SIGNATURE:	__________________________	        DATE:	___________________________

					
 APPROVED	   	FILES UPDATED	   	OFAH NOTIFIED 			CARD SENT	 January 2007