MEMBERSHIP FORM

Please print this form, fill it out, and bring it to the next meeting, 
or mail, along with a check, to:
     
            Northern Virginia Relic Hunters Association 
            c/o  Karen Eubanks-Club Secretary
            P.O. Box 5257
            Falmouth, Va. 22403



Name:_____________________________________

Check one:        New member  [ ]         Renewal  [ ]

Note: If you are renewing, please indicate any address changes below.

Mailing address:

Street________________________________
                          
City   ________________________________

State ________________________________

Zip   ____________

Email* _________________________________ 

* Your email address will be kept private. It may be used by club officers
to contact you concerning club matters only!

If you cannot attend the meetings and want your Membership card mailed 
to you, check [ ]

Make checks payable to:  NVRHA

Dues:          Family (Immediate only)        $35.00*
               Single person                  $30.00*