MEMBERSHIP APPLICATION
FOR
SIPSEY WILDERNESS HIKING CLUB
NAME:.............................................................................
ADDRESS:.......................................................................
CITY:.....................STATE:........ZIP CODE:...................
PHONE:.............................EMAIL:.................................
DATE OF BIRTH:............................................................
MEMBERSHIP TYPE:  SINGLE..........FAMILY..........
FAMILY MEMBER NAMES:........................................
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FOR CLUB USE ONLY
MEMBER STATUS
MEMBERSHIP DATE...........................
COMMITTEE.........................................
DUES PAID.............DATE.....................
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Please send check or money order only.
$15.00 single, $25.00 family to:
Sipsey Wilderness Hiking Club
P O Box 1207, Double Springs, AL 35553
Attn: Membership