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Michigan Team-1 Membership Application |
| Print this form and mail to: | Team-1 Membership c/o Thomas E Boyd 7149 Chapel View Dr Clarkston, MI 48346-1601 |
Membership year: ________________________________ New ____ Renewal ____ Name: _________________________________________________________________ Address: _________________________________________________________________ City: _________________________________________________________________ State: ________________________ ZIP: ________________________ Home Phone: ________________________ Work Phone: ________________________ Email Addr: _________________________________________________________________ Web Site: _________________________________________________________________ Birth Date: _________________________________________________________________ TRA #: ________________________ TRA Cert Level: ________________________ NAR #: ________________________ NAR Cert Level: ________________________ Most recent cert date: _____________ Location: ________________________ Other Rocket Groups: ______________________________________________________
Signed: ___________________________________________ Date: _________________