Corn Hauler L&L Club of Iowa

PO Box 632 – Des Moines, IA 50303-0632

APPLICATION FOR MEMBERSHIP

DATE:                                                              

NAME:                                                                                                                                                                                                                BIRTH DATE:                                         

ADDRESS:                                                                                                                                                                                                                                                                        

CITY:                                                                                                                                                                           STATE:                                 ZIP:                                                   

HOME PHONE:                                                                                                       CELL:                                                                                                                                               

EMAIL ADDRESS:                                                                                                                                                                                                                                                                 

TYPE OF MEMBERSHIP I AM APPLYING FOR: 

1) __________ FULL MEMBER: $25 Application Fee and $10 monthly dues ten times a year.  I realize that I will be a Pledge for six (6) months, that I must attend five (5) general meetings plus two (2) in-town Club functions and one (1) out-of-town event during this time, and that my application will be reviewed after the Pledge period for Full Membership.  I realize that if I am accepted as a full Member that I must attend four (4) functions and not miss more that three (3) consecutive meetings annually, nor may I be more than three (3) consecutive months owing in my dues in order to remain a Member in Good Standing. 

2) __________ IN-TOWN ASSOCIATE: 25.00 Application fee. I realize that if I live within the State of Iowa within a 50 mile radius of Des Moines, I will be a Pledge for a six (6) months.  I must attend at least three (3) Club functions annually.  I realize that my dues must be paid by January 31 of each year in order to remain an Associate Member in Good Standing, until such time that "Lifetime Associate Status' has been given. 

               Option A:                 Dues $15.00/year for five years.  I realize that my dues must be paid by January 31 of each year in order to remain an Associate Member in Good Standing, until such time that                                 "Lifetime Associate Status' has been given. 

            Option B:                  Dues $75.00 at the time of approval will give lifetime status.  I will then become a Lifetime Associate with no further dues obligation.

3) __________ OUT-OF-TOWN ASSOCIATE: 

             Option A:                 Dues $15.00/year for five years.  I realize that my dues must be paid by January 31 of each year in order to remain an Associate Member in Good Standing, until such time that "Lifetime Associate Status' has been given. 

              Option B:                  Dues $75.00 at the time of approval will give lifetime status.  I will then become a Lifetime Associate with no further dues obligation.

I (am currently or have been                ) / (am not nor ever have been                 ) a member of another Club.

If you are or have been a member of another club, please provide: 

CLUB NAME:                                                                                                                                      

MEMBERSHIP STATUS:                                                                                                                      

Briefly state the reason you would like to join the Corn Hauler L&L Club of Iowa: 

Applicant’s Signature:                                                                                                                                                          Date: _________________________

Sponsoring Member’s Signature:                                                                                                                                          Date: _________________________

********************************************DO NOT WRITE BELOW THIS LINE********************************************

DATE APPLICATION REVIEWED:                                                          ACCEPTED:                             REJECTED:                        

PRESIDENT’S SIGNATURE:                                                                                                                                                            

Revised: 08/2007