P.O. BOX 287
CRANE, MISSOURI 65633
(417) 723-5415
MEMBERSHIP APPLICATION
NAME OF APPLICANT: ____________________________________________________
ADDRESS: _______________________________________________________________
CITY: _______________________ STATE: ____________ ZIP: ____________________
NAME OF BUSINESS: _____________________________________________________
PERSON TO CONTACT: ___________________________________________________
TELEPHONE NUMBER: (BUSINESS)________________ (HOME) ________________
EMAIL ADDRESS: ________________________________________________________
WEB SITE ADDRESS: _____________________________________________________
| MEMBERSHIP CLASSIFICATION | ANNUAL DUES | VOTES |
| INDIVIDUAL | $ 25.00 | 1 |
| CIVIC, FRATERNAL, OR RELIGIOUS ORGANIZATION | $ 50.00 | 1 |
| BUSINESS --- (May be paid in 2 installments of $50.00) --- | $100.00 | 2 |
| Please circle appropriate dues amount: Dues should accompany application. | ||
| GIVE A BRIEF SUMMARY OF YOUR BUSINESS (What does your business do?) |
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| ______________________ Date |
____________________________________ Signature of Applicant |
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DO NOT WRITE BELOW THIS LINE |
DATE RECEIVED: ___________________ AMOUNT RECEIVED: ______________
MEMBERSHIP CLASSIFICATION: ______________ RECEIVED BY: __________