RVTA MEMBERSHIP APPLICATION

rvpatchbak.jpg (2444 bytes) FAMILY* (includes children under 16)......$25.00/year  rvpatchbak.jpg (2444 bytes)   NEW MEMBER

rvpatchbak.jpg (2444 bytes) SENIOR (16 years old and up)..................$15.00/year  rvpatchbak.jpg (2444 bytes) RENEWAL

rvpatchbak.jpg (2444 bytes) Junior (under 16 years old).........................$10.00/year  rvpatchbak.jpg (2444 bytes) Send RVTA Decal?

P l e a s e  P r  n t   a l l    i n f o r m a t i o n   l e g i b l y !

Name: ____________________________________________________________

Mailing Address: ____________________________________________________

City: ____________________________ State:__________Zip+4 ______________

Phone: (_____)________________ E-mail Address: _________________________

Please list names of adults and names and ages of children under 16:

__________________________________________________________________

__________________________________________________________________

MAIL APPLICATION AND DUES TO:
ROUND VALLEY TROUT ASSOCIATION
P.O. BOX 422
LEBANON, NJ  08833-0442

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