Club Name: __________________________________________________________________Name: __________________________________ Phone: ________________________
Address: __________________________________ E-Mail: _______________________
City: __________________________________ State: _____ Zip Code: ________
Membership Type (check one)
[ ] Club Membership [ ] Individual Membership Membership Dues (check one)
[ ] $90.00 NEW membership [ ] $30.00 RENEWAL membership
Print this page out and enclose a check to: MN Federation of Field Trial Clubs, Inc % Joseph K. Dolejsi - Treasurer 18917 Pleasantview Road Eden Prairie, MN 55346