2007 WADDRA MEMBERSHIP FORM

NAME:...........................................................................

FULL ADDRESS:...................................................................

PHONE

• (Home)..........................
• (Work).........................
• (Mobile)......................

............ $11.00 Single Membership

............ $16.50 Family Membership (Please supply all family names)

............ $5.50 Junior Under 18 Membership.

Signed:............................................

Date: ....../....../........

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Office Use Only
Amount Paid: $          Date:      /      /          Signed: