| Name: ________________________________ | Occupation: ________________________________ |
| Spouse: _______________________________
(if applying for membership) |
Occupation: ________________________________ |
| Address: ______________________________ | |
| City: _________________________________ | State: _____________ Zip Code: _______________ |
| Home Phone: __________________________ | Work Phone: _______________________________ |
| Email Address: ____________________________________________________________________ | |
| Additional Family Members: | |
| Name: ______________________ Age: ______ | Name: ______________________ Age: ______ |
| Basic KCCNY Membership (includes KCCNY newsletter, 4 issues per year): | $20.00 | ______ |
| Spouse and/or additional Family Members (one mailing per
family):
(includes voting priviledges for members over 18 years of age) |
$5.00 | ______ |
| American Canoe Association (Required):
ACA number if currently a member: _______________ |
single $30.00
family $40.00 |
______ |
| American Whitewater Association Membership (Optional):
(includes one year subscription to AWA Journal) |
$25.00 | ______ |
|
Donation towards Conservation (Optional):
(used for conservation purposes only) |
sugggested $5.00 | ______ |
|
Initiation Fee, one-time signup fee
(Manditory for new members only): |
$5.00 | ______ |
| You can help us save printing and postage costs by not receiving the newsletter in the mail. You can read the newsletters in color on the web. | Check to not recieve the printed newsletters | |
| Total: | ______ | |