Please print out this page and mail application portion along with fee in a self-addressed, stamped envelope to: Berlin Conservation Club, P.O. Box 303, Berlin, WI 54923. If you fail to send application with a SASE, your membership card will not be mailed to you...however, it will be available at the clubhouse for pickup.

Berlin Conservation Club
2011 Official Membership Record

Name________________________________________________

Address______________________________________________

City____________________________ State_____ Zip________

Phone Number_________________________________________

Email Address__________________________________________

____ $5.00 Regular Membership   ____ $2.00 Junior, 16 & under

NRA Member?   _____ Yes      _____ No