Salt Creek Wranglers

Membership/Renewal Application

Please PRINT neatly

New or Renewal (please circle one)

Start Date: ___________________

Referred by:__________________________________________________________________

Name(s):_____________________________________________________________________

Childrens names and date of birth:

1. ______________________________________________________________________
2. ______________________________________________________________________
3. ______________________________________________________________________
4. ______________________________________________________________________
5. ______________________________________________________________________
6. ______________________________________________________________________

Address:_____________________________________________________________________

City/State/Zip: ________________________________________________________________

Telephone: _________________________

E-mail: ____________________________________

Mail to: Cindy Cameron
2650 SW 23rd St.
Lincoln, NE 68522-1837

• Dues:
• Family - $35.00
• Individual - $25.00
• Lifetime - $200.00
• $10 late renewal fee applied after April 1st
• Make checks payable to Salt Creek Wranglers

Individuals 19 and over by Jan. 1st must have their own membership.