Each interested applicant should print and complete their own individual application.

Date___________

Name ___________________________________________________

Address _________________________________________________

City _________________________  State _____ Zip ____________

Phone # (______) ______________  

E-mail__________________________________________________________

Web site URL__________________________________________________
This web listing is free to paid members

Membership (Please check appropriate box)

All new memberships include a jacket patch

1 year - $5.00 youth membership  (16 & under)   Birthdate:

1 year adult -  $20.00

Renewals

1 year - $5.00 youth membership  (16 & under)   Birthdate:

1 year adult -  $20.00

Contributions: Amount__________________ Michigan Darkhouse Angling association is a recognized 501 (C)(3) non-profit Corporation. All contribution are tax deductible to the extent permitted by law.

Check  (#            )

Print out form, complete the information, and mail with appropriate funds to:  Michigan Darkhouse Angling Association,  N5160 Bass Lake Road, Iron Mountain MI 49801