DEHRC MEMBERSHIP APPLICATION

DATE: ______________________

NAME: _________________________________________________________

ADDRESS: _________________________________________________________

_________________________________________________________

Check Number: _______ Amount:________ Date:_______________

HOME PHONE NUMBER: ____________________________

CELL PHONE NUMBER: ____________________________

EMAIL: __________________________________________________________

DO YOU HAVE ACCESS TO THE INTERNET? YES _ NO _

DEHRC Secretary for 2012: John Stroud

Make checks payable to DEHRC and mail check and completed application to:

John Stroud at 598 Hardy Bridge Rd, Kinston NC, 28504

DEHRC dues: $30 per year for single membership or $50 per year for husband, wife and children under 18.