Federation of Fly Fishers - New Membership Application

Full Name:	|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
Address:	|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
City/State/Zip:	|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
Phone (home/work):	|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
Club Affiliation:	Hawkeye Fly Fishing Association
Birth Date:	___/___/___   E-mail: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
Referred By:	K99164

Please check membership category

Canadian memberships add $5 per year.  All other countries add $10 per year.

(  ) A. Individual ($29.00)		( ) C. Sponsoring ($64.00)
( ) B. 3-year Individual ($70)		( ) D. Century ($100.00)
( ) O. Senior ($22.00) for those age 65 and older		( ) L. Individual Life ($465.00) payment plans avail.
( ) B. Family ($35.00) spouses and children under 18		( ) I. Couple Life ($696.00)
( ) H. 3-year Family ($82.00)		( ) E. Retail Shop ($70.00) small fishing equip. stores
( ) Y. Youth ($11.00) for individuals under 14		( ) S. Sustaining (185.00) commercial/manuf. business
Check Enclosed (make checks payable to FFF)	U.S. Funds:    $_________
Credit Card:                       Visa                         Mastercard                        Discover
CC# _____________________________________ Exp. Date ____________________

Please mail or call us at:

Federation of Fly Fishers
PO Box 1595	(406) 585-7592
Bozeman MT 59771	(406) 585-7596 fax