WRRC Membership form



Fill out on computer and print or print off and fill out by hand.

Name:

Street:

City:

State: Zip:

Email:

Phone:

 

______

New Renewal

 

Individual - $12        Couple (or parent\child) - $20        Family - $25


Family Members included in membership:       

Name

Email

 

Name

Email

   

Name

Email

  

Name

Email


Couple and family membership must have one street address.


Please send your completed form with check payable to Wabash River Runner's Club and mail to:

Wabash River Runner's Club
PO Box 2493
West Lafayette, IN 47996-2493


CLUB USE ONLY
Expiration Date:________