Name: ___________________________________________Home Phone: ________________________
Address: _____________________________________________________________________________
City: __________________________________State: _____Country: __________ Zip:_____________
Cell Phone: ____________________________ Fax No: _______________________________________
Email: _______________________________________________________________________________
Name of Business: ____________________________________________ Bus Phone: _____________
Profession: ___________________________________________________________________________
Club Affiliation: _______________________________________________________________________
Web Site: ____________________________________________________________________________
How did you learn of IWFF? ___ Ad in Newsletter/Magazine (specify which) ____________________
___ Local Club Referral ___ Other (specify) _______________________ Where would you like to have an IWFF Festival held? _________________________________________
Do ___Do not ____include my name on the membership roster which will be distributed to the membership of IWFF and is for personal use.
Do ___Do not ____include my name on mailing lists released by IWFF Board of Directors to outside entities associated with fly fishing.
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General Annual Membership |
$ 25.00 US $30.00 International |
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Membership Discount: Pay for 5 years up front and save! |
$100.00 US $120.00 International |
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Reduced Membership (must be 18 years or younger) |
$ 15.00 US $20.00 International |
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Mail this form along with dues to:
International Women Fly Fishers 6404 Lagunitas Ave. El Cerrito CA 94530 |
For more information contact: Rebecca Blair 510-215-2824 rebecca_blair@sbcglobal.net
Fanny Krieger fannykrieger@mac.com
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I would be interested in joining a committee. Please circle. Festival Membership Education Industry Newsletter Conservation Public Relations Historian Website Club Liaison Other: _________________________
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Credit card: ___ Visa ___ Mastercard ___ Discover ___American Express
Card Number: _______________________________________________________ Expiration Date: ____________________
Authorized Signature: ___________________________________
WAIVER OF LIABILITY
In consideration of participating in International Women Fly Fishers activities and/or events, I hereby indemnify and hold harmless and release the International Women Fly Fishers, its Officers, Board of Directors, Members and Agents from any and all liability for any injury suffered by myself, or my minor children, arising from or connected with club activities or events. I assume all the risk for any injury received and agree to hold the International Women Fly Fishers free and harmless from any and all costs, expenses and attorneys fees incurred in connection with any action, claim or demand brought thereon. I further agree to abide by all terms and conditions set forth in the club by-laws and regulations.
Signature: _________________________________________________________ Date: ____________________
Membership runs from January 1st through December 31st.
If you’ve entered an email address, your newsletter will automatically be emailed to you at that address.
If you have any questions regarding your membership status please contact me:
Rebecca Blair Rebecca_blair@sbcglobal.net