NEW MEMBER __________

RENEWING MEMBER_______

There will be a $5.00 office fee added to each renewal membership purchased after May 1, 2008

NAME:_______________________________________________________________________ ADDRESS:____________________________________________________________________ CITY:______________________________________STATE:____________ ZIP:___________ HOME PHONE: ______________________BIRTH DATE:______________________________ EMAIL ADDRESS:_______________________________________________________________ _____$25.00 Individual Pkg Membership ______$35.00 Family Pkg Membership Individual Membership includes: Membership card, Blue Book and Rule Book and back numbers (1 set of 2 per person). Back numbers range 1 - 250 only. No other numbers may be purchased. Family Membership Includes: Husband, wife, unmarried children 18 years of age and younger living at home. Any person who has reached the age of 19 (as of January 1st of the current year) is no longer considered a youth and is required to have his/her own individual membership and will no longer be covered under a family membership. Name:__________________________Birth Date:____________Back Number Request________ Name:__________________________Birth Date:____________Back Number Request________ Name:__________________________Birth Date:____________Back Number Request________ Name:__________________________Birth Date:____________Back Number Request________

Make Checks Payable to BWPHA Mail Application to Point Secretary Stephanie McCrea 1315 North Van Dyke, Bad Axe, MI 48413 slou_57@hotmail.com

Point Secretary Use Only BWPHA# ____________________________ Date Received:_______________________ Amount Paid:________________________ Check#_____________________________