Membership year: October 1 through September 30.
NEW ( ) RENEWAL ( )

NAME: __________________________ NAME: _________________________________

Address: _________________________________ Changed ? Yes ____ No ____

City: _____________________________ State: ________________ Zip Code: __________

Phone: ___________________________ E-Mail: _________________________________

--..--..--..--..--..--..--..--..--..--..--..--..--..--..--..--..--..--..--..--..--..--..--..--..--..--..--..--..--..--..--..--..--..
I M P O R T A N T

[__] Please check here if you do not wish the above information to appear on the internet.

--..--..--..--..--..--..--..--..--..--..-..--..--..--..--..--..--..--..--..--..--..--..--..--..--..--..--..--..--..--..--..--..--..

Signature * __________________________________ PFHA #: ________________________

Signature * __________________________________ PFHA #: ________________________

" To authorize assignment of names to Great Lakes Region for representation at Board of Directors meetings.

" FAMILY - $27.00 U.S.
Full voting member. Two family members 18 or older, one of whom is the head of the household. Consists of 2 regular memberships and unlimited associate memberships.
" REGULAR - $14.00 U.S.
Full voting member. No regular memberships will be issued to anyone under age 18.
" ASSOCIATE - $12.00 U.S. A non-voting member enjoying all association benefits.
Names: 1. ___________________________ 2. _________________________________
" YOUTH - $12.00 U.S. A non-voting member enjoying all association benefits.
Names: 1. ___________________________ 2. _________________________________

MAKE CHECK PAYABLE TO: G.L.P.F.H.A.

Send application and dues to: Kathy Pfister
4098 Groveland
Ortonville, MI 48462