WOOSH Membership Application

Print it out and send it in today!

Membership dues are $10.00 annually for those 21 and over and $5.00 for those under 21.

Membership Type:  ___Age 21 Years & Over ($10)     ___Age 20 Years & Under ($5)                                                    


Name:_________________________________________

Address:_____________________________________________

City:______________________________

State:______ Zip:____________

Home Phone# ________________ Work Phone# _______________
Birthdate:_____/_____/_____

NAR# (If applicable):___________  TRA# (If applicable):____________

High Power Certification Level (Circle one):   None    1    2    3

Email Address (If applicable):________________________________
Would you like your own wooshrocketry.org email address?   Yes    No
If Yes, what email name would you like?______________________________
Website Address (If applicable):___________________________________

Select a newsletter delivery method:  

 ____Paper by mail
 ____PDF file electronically

Type of membership:
____New
____Renewal
 
Make check or money order payable to:

Darlene Jarosch, WOOSH Treasurer

Please mail to:

Darlene Jarosch
738 S. 113th St.
West Allis, WI  53214