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North American Rat & Mouse Club, International Registration Form
(Circle) New Membership - ; Renewal of Membership - ; Youth Membership - ( w/proof of 4-H membership)
Name:_________________________________ Birthdate: (OPTIONAL)_____________
Rattery/Mousery Name:______________________________________________
Address:_____________________________________________________
_____________________________________________________________
City:_____________________________________State:_____________________
Zip Code:______________Country:__________________________________
Nearest Big City:__________________________________________
E-mail Address: (OPTIONAL)_______________________________
IM Screen Name: (OPTIONAL)________________________________
Home Phone: _______________________________________________
Work Phone: (OPTIONAL)_______________________Ext._____
Spouse (SO/Partner/etc.): _______________________________________________
Children: _______________________________________________
Critter Type(s): _______________________________________________
Do You Breed? Yes No
Describe: ________________________________________________
Rescue? Yes No
Details: _______________________________________________
Club Affiliations: _______________________________________________
Interests: (OPTIONAL) _______________________________________________
________________________________________________________
I would like to help the club out with:
___writing for the Journal or chapter newsletter
___helping with mailings
___helping with meetings
___making phone calls
___getting publicity for the club
___staffing at shows
___Health Examiner ___Show Secretary ___Steward
___Clerk ___Announcer ___ Program ___Ribbons ___Sponsors
___Trophies ___Set up/break down ___Publicity ___Vendors
___other _____________________________________________
I am applying for membership in the North American Rat & Mouse Club, International (NARMCI). I have enclosed my annual dues of .00 (Twenty USD) (Canada, Europe, Australia - please inquire, it will be the additional postage of the newsletter to your country). I understands this entitles me to a year subscription of the NARMCI Journal, the NARMCI Ruled Book and to all membership benefits.
Signature: _______________________________________ Date: _________
Signature of Parent or Gardian if under 18: ______________________________________________
Mail this form and payment to: NARMCI, Candy Evans, 104 N. Lincoln Ave., Wenonah, NJ 08090
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