FINGER LAKES RETRIEVER CLUB

MEMBERSHIP APPLICATION

Name:

_______________________________________________________

Address:

_____________________________________________________

City:

___________________

State:

________________

Zip:

_________

Telephone Number:	_________________________________ (HOME)
	_________________________________ (WORK)

Email Address:

_______________________________________________

Number of Retrievers Owned:

__________

Ages:

____________________

Please Circle Your Areas of Interest:

Training/Seminar Days

Family Fun Days

July Hunt Test

Upland/Waterfowl Hunting

I would like to receive FLRC Newsletters:

by email

by US mail

Would You Be Willing To Offer Your Assistance For Club Functions:

Yes

Membership Fee: $20.00

Mail To:

Please make checks payable to:	Carol Lantiegne
FLRC	239 Fravor Road
	Mexico, NY 13114