Membership Application, Dwight Lydell Chapter, Izaak Walton League of America
Effective 1-1-2005

NAME _______________________________________________________

Home Phone (___) _______           Business Phone (___) _______

SPOUSE _____________________CHILDREN (with ages) _________________________ 

ADDRESS ___________________________City______________________
 
State ___ ZIP _________ 

Date: _______________   E-mail address _______________________________________

Dwight Lydell Chapter Membership

$50 ---> Individual $68 ---> Family $24 ---> Student $13 ---> Youth (under 18)

Sponsor __________________________________________________

Mail to Bob Stegmier, 5285 Windmill Dr. Rockford, MI 49341. 

Checks payable to : Izaak Walton League

Call Bob at 616-866-4769 for more information.

The Izaak Walton League of America - a non-profit conservation organization - 
is recognized as a Section 501(c)(3) public charity under the Internal 
Revenue Code. Minimum national dues (included in the above rates) 
are $36 for individual and $54 for family memberships, which includes $4 for 
Outdoor America magazine. Magazine is inseparable from dues. 
Chapter and Division dues may vary.