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MEMBERSHIP APPLICATION FORM
NAWGJ Identification Number: ___________________ Date ____________
Region: _____________________
State: ______________________
USAG Pro #: __________________
Current
Ratings: _____________________
MEMBERSHIP FEES (check one)
____Professional
($55)
Includes Insurance
____New ($45) (1st Year Levels 8 and/or Level 5/6 Judge only) Includes Insurance
____Associate
($35)
(Non-Judge: Coach, parent)
Late
Charges: 30 to 90 days: $5 - Past 90 days: $10 Restart Fee $10
NAME ___________________________________________________________________
ADDRESS ________________________________________________________________
________________________________________________________________
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Do you have a NAWGJ
Navy Uniform |
YES
NO |
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(Circle
One) |
PHONE ( ) _____________
FAX ( ) _____________
E-mail: __________________
Make check payable and Send Application & Check To:
NAWGJ-BETTY SROUFE, Secretary/Treasurer
2096 Rolling Hills Blvd, Fairfield, Ohio 45014
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