Form should print at 5 3/8" by 4 1/4"

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|                                                                                    |
|          OTTAWA SPORTSMEN'S CLUB  -  PO Box 475  -  Baraga, MI  49908              |
|                                                                                    |
| Membership Application:  I hearby apply for membership in the Ottawa Sportsmen's   |
| Club Inc. of the Upper Peninsula.  It is understood this application is subject    |
| to approval by the Membership Committee of the Club.                               |
|                                                                                    |
|                                                                                    |
| NAME______________________________________________________________________________ |
|           First             M.I.     Last                                          |
|                                                                                    |
| ADDRESS___________________________________________________________________________ |
|           Number            Street              /        PO Box                    |
|                                                                                    |
| ________________________________________________________   D.O.B._____/_____/_____ |
|           City              State   Zip                                            |
|                                                                                    |
| PHONE_____________________________________________________________________________ |
|              Home                Work                      Other                   |
|                                                                                    |
| OCCUPATION______________________   E-Mail_________________________________________ |
|                                                                                    |
|                                                                                    |
|----------------------------------------+   INITIATION FEE $ 10.00                  |
|                                        |   ANNUAL DUES    $ 25.00                  |
|       Approved     Disapproved         |   ----------------------                  |
|                                        |   TOTAL          $ 35.00                  |
|                                        |                                           |
|  This______day of_____________20_____  |                                           |
|                                        |  ________________________________________ |
|                                        |           Signature of Applicant          |
|  By__________________________________  |                                           |
|     Chairman of Membership Committee   |  ________________________________________ |
|                                        |                 Sponsor                   |
|                                        |                                           |
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