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BLACK HILLS CLIMBERS COALITION
MEMBERSHIP APPLICATION
Please
fill out and return with dues to:
Jim Slichter
c/o BHCC
24102 Jacob Maca Drive
Hill City, SD 57745
Copies of the By-Laws and Standard Rules
of Operations can be obtained from any Club Officer
________________________________________________________________________
This application is
for an (check one) ______ individual membership @ $10.00 per
year or for a ______ family membership @ $20.00 per year.
All memberships
expire on the first of August each year.
Name:
____________________________________________________
Address:
__________________________________________________
City/State &
Zip____________________________________________
Home Phone:
______________________________________________
Work Phone:
_______________________________________________
E-Mail Address to Receive
Newsletters___________________________
Climbing Level: (Circle
One) 5.0-5.7 5.7-5.10 5.10-5.12 5.12-Over
For Family
Membership, please list other family members:
#1__________________________________________________________________
Name
Relationship Age Skill Level
#2__________________________________________________________________
Name
Relationship Age Skill Level
#3__________________________________________________________________
Name
Relationship Age Skill Level
#4__________________________________________________________________
Name
Relationship Age Skill Level
#5__________________________________________________________________
Name
Relationship Age Skill Level
#6__________________________________________________________________
Name
Relationship Age Skill Level
I certify that I am
twenty-one years (21) years of age or older and agree to
abide by the By-Laws and Standard Rules of Operation of the
Black Hills Climber’s Coalition.
____________________________
____________________________
Signature
Date Spouses
Signature Date
For Black Hills Climber’s Coalition
use only
Date Received____________ Amount
of Dues Received___________
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