Membership Application Form

NAME: _______________________________________________

ADDRESS: _____________________________________________

CITY, STATE, ZIP: _______________________________________

EMAIL: _______________________________________________

TELEPHONE:___________________________________________

Amount Enclosed:____________

Dues are $10 per year. Please print this page and sent it along with your check (payable to WI-IL NARGS) or cash to the treasurer: Jean Halverson, P.O. Box 101, Dodgeville WI 53533