Southwest Dragboat Association

PO Box 35189

Albuquerque, New Mexico 87176-5189

2007 Associate Member Registration Form

Name:                                                        Day Phone:                                                  

Evening Phone:                                          E-Mail:                                                        

Address:                                                                                                                                

City:                                               State:                          Zip:                                       

SSN#                                                     DOB:                                               

Associate Member Fee:

$35.00 if paid by March 30, $50.00 thereafter

(Fee may be applied to full membership)

Includes:

1 Rulebook, Newsletters, Voting Privileges

Make Checks payable to:

Southwest Dragboat Association

For Official Use Only

             $35.00 Paid                                                                Chk 

                                                                                                 Chk Number

                                                                                                 Cash

Initials of Officer:                                                      Date: