Application

~ Application for Membership ~
in
The Wilderness Center Astronomy Club

NOTE: You MUST be a member of The Wilderness Center before you can join the Astronomy Club!

Print form and fill it out (remember to add the total of your selections)
Bring to meeting or mail the completed form and check to:


The Wilderness Center Astronomy Club Treasurer - Ken Craddock PO BOX 202 Wilmot OH 44689-0202


_________________________ First Name		________________________ Last Name

______________________________________________________ Street Address

_________________________ City		________________________ State

_________________________ Zip		_______________________ Date

( ______ ) _______________ Phone Number		_________________________ E-mail

**Membership Options**
WCAC membership ($12.00/yr. per family)	$12.00


Total	$________
Your check number #	________