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Membership app SCI OSC 040711 MJM

Visit Our Website: www.oklahomastationsci.org Email oscsci@yahoo.com * Phone 405-703-3381 * Fax 405-735-9537

Membership Application

Safari Club International - Oklahoma Station Chapter

[see separate form for Lifetime Chapter Membership]

Name: Address:

City, State: Zip Code:

Home Phone : ( ) Cell Phone: ( )

E-Mail:________________________________________________________ @____ ____ ___________________ ____________

Day/Office Phone: ( ) FAX: ( ) Pager: ( ) __________________

Other Phone: ( ) ________________ Web Site: _________________________________________________________

or specify________________:

________________________________________________________________________________________________________

Signature: _________________________________________________

: ________________________________ _______________________

Check One:

_____ Yes, I support the Safari Club International's and the Oklahoma Station Chapter's goals of conserving wildlife and protecting the hunter. Please enroll me as a chapter and national member for $95.00. I realize that my membership fees include a $30 chapter membership. The

national membership fee of $65 includes an annual subscription to the monthly Safari Times

newspaper and bimonthly magazine, The Journal of Safari Big Game Hunting.

_____Yes, I support the Safari Club International's and the Oklahoma Station Chapter's goals of conserving wildlife and protecting the hunter. Please enroll me as a chapter member for $30.00 I understand that to enroll as a chapter member, I first must be a member in good standing of Safari Club International. My SCI Membership number is:

_______________________

OTHER SCI MEMBERSHIP OPTIONS (Check One)

Annual ____ $ 65 (USA, Canada, Mexico) ____$ 90 (all other countries) Three-year ____$ 150 (USA, Canada, Mexico) ____$ 225 (all other countries) Life Member ____$1,500 (USA, Canada, Mexico) ____$2,000 (all other countries) Senior Life (60 Years old +) ____$1,250 (USA, Canada, Mexico) ____$1,750 (all other countries) Spousal Life ____$ 750 (USA, Canada, Mexico, all other countries) [no publications]

PAYMENT OPTIONS: Authorized Amount: _______________ ________Check (Make check payable to SCI)

____Visa____ MC Card Account #: ___ _______ _______________________ 3 Digit # on Reverse side of card________ (Absolutely necessary) Expires: _____________ _______ Cardholder signature ___________________________________

Reminder: We cannot process your credit-card order without the expiration date & 3-Digit #

Please return this form with the appropriate fees to:

Dennis Elliott, MembershipChairman 9642 S. Quebec Ave., Tulsa, Ok. 74137

Email delliott59@aol.com * Phone 918-298-8299 * Fax 918-298-3013

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