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Membership app Lifetime OSC 040711 MJM

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

Membership Application -- Lifetime

Safari Club International - Oklahoma Station Chapter

Application for Lifetime CHAPTER Membership

(You must maintain an active membership in Safari Club International for Lifetime Chapter Membership in the Oklahoma Station Chapter to be in effect.)

Name: Address:

City, State: Zip Code:

Home Phone : ( ) Cell Phone: ( )

E-Mail:________________________________________________________ @____ ____ ___________________ ____________

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

Other Phone: ( ) ________________ Web Site: _________________________________________________________

Other Mail or specify________________:

________________________________________________________________________________________________________

Signature: _________________________________________________

: ________________________________ _______________________

Check One:

__________ Yes, I support the Oklahoma Station and Safari Club International's goals of conserving wildlife and protecting the hunter. Please enroll me as Lifetime Chapter Member. I understand that this enrollment will entitle me to a permanent subscription to the chapter newsletter, The Oklahoma Safari Trails,

and all other publications and/or notices that are sent to active chapter members. Iam under the age of 65 and am enclosing the lifetime chapter membership fee of $750.

_______ Yes, I support the Oklahoma Station and Safari Club International's goals of conserving wildlife and protecting the hunter. Please enroll me as Lifetime Chapter Member. I understand that this enrollment will entitle me to a permanent subscription to the chapter newsletter, The Oklahoma Safari Trails,

and all other publications and/or notices that are sent to active chapter members. I am at least 65 years of age and am enclosing the lifetime chapter membership fee of $500.

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

____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, Membership Chairman 9642 S. Quebec Ave., Tulsa, Ok. 74137

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

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