Application for Membership in the MASSACHUSETTS
BEACH BUGGY ASSOCIATION (a non-profit organization). DUES PAYABLE
JANUARY 1ST.
I (we) have read the Code of Ethics and
will abide by them to the best of my (our) ability
_________________________________________________________________________________
Signature
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__________________ |
Name(s)(please print) |
Membership #(s) |
Mailing Address:
| ____________________________ |
_______________________ |
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Street |
City |
State |
Zip |
E:Mail Address:________________________________________________
Internet Access: (home, office, library) _______yes _______no
Usual Fishing Area:____________________________ Telephone #_____________________
How did you hear about us:______________________________________________________
Dues: New Member Single Dues $10.00. New Couple
Dues $20.00
Junior Members (@$5.00 per junior member):
| ___________________________________ |
_________________ |
__________ |
| Name |
Date of Birth |
Member # |
| ___________________________________ |
_________________ |
__________ |
| Name |
Date of Birth |
Member # |
| ___________________________________ |
_________________ |
__________ |
| Name |
Date of Birth |
Member # |
Membership Number Decals (one set comes with new membership **$5.00
per set for extra membership numbers)
| ___________________________________ |
_________________ |
__________ |
| Membership # |
Quantity |
Total |
| ___________________________________ |
_________________ |
__________ |
| Membership # |
Quantity |
Total |
MBBA Jacket Shoulder Patch ($5.00 each)
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_________________ |
__________ |
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Quantity |
Total |
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| Donation to: ........................................................ |
MBBA Legal Fund |
__________ |
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| Donation to: ........................................................ |
MBBA General Fund |
__________ |
Make Checks Payable to : MBBA.
Mail form and check to:
Jessy Snell
Membership Secretary
PO Box 266
Hanson, MA 02341
**Extra Decal set includes: 2 State decals & 2 sets of your
MBBA numbers
Contact MBBA webmaster
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