Rats PacNW Membership Application Form


Name:    1)_________________________________________________


               2)___________________________________________________


               3)___________________________________________________


               4)___________________________________________________


               5)___________________________________________________


               6)___________________________________________________


Address:  1)__________________________________________________

                 ___________________________________________________

                 ___________________________________________________

Phone: __________________________

Email: _____________________

Membership type:

___   $10.00 Individual Membership

___  $5.00 Junior Membership (12 and under - no voting privileges)   

___  $17.50 - Family Membership - 13 and older (husband/wife, SO/SO, Parent/child, sibling/sibling);

            
$5 for each additional household member 13 years of age and older,
$2 for 12 and under (please indicate which family members are 12 and under if any)

Total Membership Fees:  $____________  

Please make check or money order payable to RatsPacNW and send form to:

RatsPacNW Membership Committee
c/o Jamee Boardman
8493 Spring Creek Road SE
Port Orchard, WA 98367