Kansas & Oklahoma Steam & Gas Engine Association
E.D.G.E. & T.A. Branch 11

Membership Application

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DUES:
$25.00 Per year for the man of the household.
All male members under the age of 18 pay $10.00 each.
All females pay $10.00 each.

Everyone paying dues will be covered by National Insurance.

Send dues to:
                                  Marion Futhey
                                  14024 SW Prairie Creek Road
                                  Rose Hill, Kansas 67133

Dues are due on or before March 1st. So that National Membership and Insurance criteria can be met by April 1st of each year. National's calendar year runs from April 1st to April 1st.

Today's Date:____________

Full Name:______________________________________________

Birth Date:_____________

Spouse's Full Name:______________________________________

Spouse's Birth Date:____________

Address:________________________________________________

City:___________________________________________________

State:__________________

Zip Code:___________

E-mail Address:__________________________________________

Wedding Anniversary Date:_________________

Home Phone:______________________

Cell Phone:_______________________

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Renewal____ New Member____ Paid Cash____
Amt. Pd by Check $_______ Check #________ By Mail_____

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Last Updated Wednesday, September 03 2008 @ 09:10 AM CDT