Mail applications to:

                                     Avon Anglers Inc.,  P.O. Box 101, Avon. N.Y. 14414                                

Meetings on the 1^st Wednesday of every month

TYPE OF MEMBERSHIP:    ______JUNIOR    ______REGULAR    ______SENIOR

LAST                                                      FIRST                                                     MI 

                NAME: ___________________________________________________________________________________________________________________________________________

 STREET / P.O. BOX                                                                                          CITY                                                       STATE                                   ZIP

  ADDRESS: _______________________________________________________________________________________________________________________________________________

                                                   TELEPHONE #: _____________________ AGE: _______________SEX: M ___  F___

             E-MAIL ADDRESS:__________________________________________

 FEE: _________________                                     EFFECTIVE DATE: __________________

 BOATER: _____   NON-BOATER: _____ ___________________________________________________________________________________________________________________________________________________________________________

                                                                                1^st YEAR FEES:        JUNIOR       11 - 16YRS  -  $10.00           ANNUAL FEES:      JUNIOR        $5.00

                                                                                                                  REGULAR    17- 59 YRS     $20.00                                             REGULAR     $15.00

                                                                                                                   SENIOR         60+ YRS        $15.00                                               SENIOR       $10.00

 I hereby proclaim that I will represent the organizational statement of the Avon Anglers Unlimited Inc.

 SIGNATURE: _______________________________________________         DATE: ____________________ 

Make checks payable to: Avon Anglers Inc.