2010 Adult Membership Form

Membership:               Renewal                New

Membership:               Regular - $75 (MFBA - $25, TBF - $15, FLW-$35)

                                                      Premium - $100 (MFBA - $50, TBF - $15, FLW-$35)
                         (Premium Members may send a representative to required tournament meetings vs. attending in person)

Make checks payable to MFBA, mail check and form to MFBA, 19833 W. Ford Brook Dr., Anoka, MN, 55303

FLW Member No:   _____________________

Name:                        _________________________________________________

Address:                   _________________________________________________

City:                           _____________________State:  ______  Zip: ___________

Gender:                         Male      Female                Birth Date:  _________________

Email Address:       ________________________________________

Primary Phone:           Cell                   Home                       Work
                                   ________________________________________

Club:        New          ____________________________(complete New Club Form)

Existing    ____________________________

                  Umbrella

o       Would you be interested in joining an existing MFBA club?

o       Would you be interested in starting/joining a new MFBA club?

Interests (check all that apply):

Tournaments                                              Youth

Conservation                                             Other       __________________

Education