Membership Application, Dwight Lydell Chapter, Izaak Walton League of America
Effective 1-1-2010

NAME _______________________________________________________

Home Phone (___) _______           Business Phone (___) _______

SPOUSE _____________________CHILDREN (with ages) _________________________ 

ADDRESS ___________________________City______________________
 
State ___ ZIP _________ 

Date: _______________   E-mail address _______________________________________

Dwight Lydell Chapter Membership Dues:

Individual -       $50
Family  -          $68 
Student (18-21) -  $24
Youth (under 18) - $13

(If you want a gate key to walk the grounds, add $5)

Sponsor __________________________________________________

Mail to Ron Waybrant, 4905 Cresthill NE, Grand Rapids, MI 49525. 

Checks payable to : Izaak Walton League

Call Ron at 616-361-1422 for more information.
(E-mail him at  rcwaybrant@gmail.com)

The Izaak Walton League of America - a non-profit conservation organization - 
is recognized as a Section 501(c)(3) public charity under the Internal 
Revenue Code. Minimum national dues (included in the above rates) 
are $36 for individual and $54 for family memberships, which includes $4 for 
Outdoor America magazine. Magazine is inseparable from dues. 
Chapter and Division dues may vary.