Club Name:  __________________________________________________________________

Name:       __________________________________ Phone: ________________________

Address:    __________________________________ E-Mail: _______________________ 

City:       __________________________________ State: _____ Zip Code: ________

Membership Dues (check one)
[ ] $90.00 NEW membership     [ ] $30.00 RENEWAL membership

Print this form and enclose a check made out to MFFTC

Send to:

MN Federation of Field Trial Clubs, Inc
% Joseph K. Dolejsi - Treasurer
18917 Pleasantview Road
Eden Prairie, MN 55346