Membership app Lifetime OSC 040711 MJM
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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
* Phone 918-298-8299 * Fax 918-298-3013
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