NDAE4-HYW Membership Renewal Form

2009-2010 Membership Form

NAME _____________________________________________

TITLE _____________________________________________

OFFICE ADDRESS ____________________________________

CITY STATE ZIP _____________________________________

PHONE _________________________________________ FAX ________________________________

EMAIL _____________________________________________

TYPES of MEMBERSHIP
Check one:

_____ $ 80 State & National Membership Dues

_____ $ 10 State Association Dues (Only available for staff that are less than 50% time.)

_____ $210 Life Membership (Available to former members upon retirement.)

_____ $ 45 NEW MEMBERS ONLY! (National dues are only $35 your first year and state dues are $10.00.)

Please make checks payable to NDAE4-HYW and send to TREASURER:
Jodi Bruns
NDSU Extension Service/Dickey County
PO Box 40
Ellendale, ND 58436-0040