Membership Information Sheet

Membership Status
New Member
Renewal (Personal information change)
Name (Last, First)   Gender M    F
Occupation   Work Phone  
Spouse Name (Last, First)  
Occupation   Work Phone  
Address
Home Phone   Email  
In Case of Emergency, Notify: Name  
Phone  
Other family members: Name   Relationship  
Name   Relationship  
Name   Relationship  
Name   Relationship  




Signature: ______________________________ Date: ____________________

Annual Membership Fee :  $5 per family
Check Payable:                 NW HIKERS ASSOCIATION
Mailing Address:                7910 125th CT SE  Newcastle, WA 98056