For Year _____________

Name__________________________________ Spouse____________________
(print full name)

 Address_________________________________________________________
                        Street or rural route/ box number or apt. no.

City________________________________ State__________ ZIP___________

E-mail_________________________ Telephone____________________

HRC requires that when you belong to a local club, you must also belong to the national Hunting Retriever Club.

If you already belong to H.R. C., please provide your membership number______________.

Our club dues run 2/1 through 1/31.

Types of memberships offered:   Individual - $15_____ Family - $20_____

Please return the application and check payable to Tri-State HRC to: