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Alabama
Hunter Education Association
Membership Application
Date ______________________
Name: ____________________________________________________
Address ____________________________________________________
Address ____________________________________________________
City ____________________________________________________
County __________________________________County # ___________
State ___________ Zip _____________
Wildlife District 1 2 3 4 5 6 (Circle)
Instructor Number ____________
Telephone (Home)__________________________(Business)_________________
E-mail ________________________________
Annual Membership $15 _________________ (Dues renewed in Jan. each year)
5 Year Membership $70 _________________
Life Membership $275 _________________
Members of any of the following:
NRA____ NWTF____ NBHA___
NMLAS____
DU____ AWF ______
BSA/GSA____ 4H Shooting club___ ROTC Shooting club____
OTHER Organizations:______________________________________________________
________________________________________________________________________________
Office Use:
Date Processed: _______________________
New or Renewal _______________________
Voting Member _______________________
Membership packet Sent _______________________
Added to Email _______________________
Fee Recorded _______________________
Processed by: _______________________
Return to: Ricky Moss, 20621 Edgewood Road, Athens, AL 35614