Date____________________

Approved _______Denied______

Paid______Date__________

Membership Form

2007

Name______________________________________________________

First, MI, Last

Address___________________________________________________

Street Address Apt No./ Suite

City_________________________State_________Zip______________

Phone_________________________Phone_______________________

(Area Code) Home/ Business/ Cell (Area Code) Home/ Business/ Cell

Date of Birth______________Email_____________________________

Would you like to volunteer with the Rodeo? If so what would you like to do?_________________________________________________ ____________________________________________________________________________________________________________________

Do you have any special abilities that you would like to share with the Salem Rodeo? __________________________________________

____________________________________________________________________________________________________________________

Do you have any disabilities that would stop you volunteering? ____

__________________________________________________________

(Office Use Only Below)

Membership Card__________ Tickets__________________

Annual Meeting____________ Other___________________