2012 Junior Membership Form

Membership:               Renewal                New

Membership:               Regular - $30 (MFBA - $25, TBF - $5)

                                                      Premium - $50 (MFBA - $25, TBF - $25)

Make checks payable to MFBA, mail check and form to MFBA,  690 8^th Ave. NW, New Brighton, MN, 55112

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 Junior club?

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

Interests (check all that apply):

Tournaments                                              Youth

Conservation                                             Other       __________________

Education