2012 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,  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 club?

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

Interests (check all that apply):

Tournaments                                              Youth

Conservation                                             Other       __________________

Education