Applicants must be current members of WINNEBAGO-ITASCA TRAVELERS (WIT)

NAME____________________________________________________________________

 

SPOUSE/COMPANION_______________________________  WIT # _________________

 

ADDRESS_________________________________________________________________

 

CITY_________________________________STATE___________ ZIP_______________

 

E-MAIL ADDRESS _________________________________________________________

 

RESIDENCE PHONE_________________________CELL PHONE______________________

 

MEMBER OF WHAT LOCAL CHAPTER____________________________________________

 

ARE YOU WILLING TO VOLUNTEER TO HELP AT STATE OUTINGS AND RALLY?________

 

DUES:  $10.00 per year (due in September each year)

 

SIGNATURE________________________________________DATE___________________

 

SIGNATURE________________________________________DATE___________________

 

 

In case of emergency, notify (other than spouse or traveling companion): 

 

Name:______________________________________________

 

Telephone Number:___________________________________

 

Relationship:______________________________________

 

Please mail your application along with your check made

 payable to ILLINOIS INDIANS for $10 to: