MWD Membership Application - Midwest Division of TCA

HomeMWD Membership Application

Midwest Division Application for Membership

Midwest Division of TCA, PO Box 934, Grayslake, IL 60030

Date________________________

Name______________________________________________________________________________

Address____________________________________________________________________________

City___________________________________, State____________ Zip Code_____________________

Phone #______________________-____________-__________________________________________

National TCA #_______________________________________________________________________

E-Mail Address__________________________________@______________________._____________

(Your e-mail address will be used for MWD information only)

Membership Fee $30.00 covers MWD yearly dues and door fees for all MWD meets.

Family Membership is an additional $5.00 to the Regular or Annual membership fee. This allows your

spouse and any children under 17 years of age free admission

Total Check Amount $ ___________________

Family Membership Information:

Spouse (Name)______________________________________________________________________

MWD Sponsor (Name) TCA#

(Children ages 17 and under free - Please List Names and Ages)

Child (Name)____________________________________________________Age_________________

Send completed application with payment to:

Midwest Division TCA

P.O. Box 934
Grayslake, IL 60030