Ozark Fly Fishers, Inc Membership Application

.Name _______________________________________ Date _______________________

Street Address ________________________________ Spouse _____________________

City/State ____________________________________ Zip Code +4 _________________

Home Phone ________________________   Cell Phone __________________________

E-mail address _______________________________________________________              

Membership:   ______New         _____Renew

A renewal would include anyone who has been a member in the past five years.

Family Members included:(Family Memberships Only)

Name _____________________________________________________________________

Home Phone __________________________    Cell Phone __________________________

 E-mail address _____________________________________________________________

Dues (Check only ONE item below)

____Individual $30        _____ Family $40          ____Student $15            ____ Corporate $250

Personal information may not appear in the Membership Directory if renewal is made after January 25th. Membership paid in October or later is automatically renewed through the following year.

Other Club Memberships (Check all that apply)

____Conservation Federation MO          ____Trout Unlimited ____Fly Fishers International                  ____Smallmouth Alliance

F.F.I. members who are Illinois residents should request membership in the Southern Council on their F.F.I. membership application or by sending an email to membership@flyfishersinternational.org

Fly Fishers International Recognition (Check all that apply.)

____Certified Casting Instructor            

____Master Certified Casting Instructor (Highest level will be noted in directory.)

____Bronze Fly Tying Award    ____Silver Fly Tying Award    ____ Gold Fly Tying Award 

Mail this form and a check payable to Ozark Fly Fishers, Inc. Please do not staple the check to this form.

Dan Staggenborg Note: Some information on this application will be Membership Director, Ozark Fly Fishers included in the published Membership Directory. PO Box 31473 If you do not wish to have your information included, Saint Louis, MO 63131-0473 please let us know.

For additional information or questions contact Dan Staggenborg: danstag@att.net or 314-313-8327

Agreement for Membership/Waiver of Liability In consideration of participating in Ozark Fly Fishers, Inc. activities and/or events. I hereby indemnify and hold harmless and release Ozark Fly Fishers, Inc.: it’s officers, Board of Directors, Members and Agents from any and all pilfer, and any injuries suffered by myself arising from or connected with club activities or events. I understand the inherit risk in participating in activities of the Ozark Fly Fishers, Inc. and assume all risk for any injury received and agree to hold the organization free and harmless from any cost, expenses and attorney’s fee incurred in connection with any action claim or demand thereon.

Signature ______________________________________ Date ________________________

Member Newsletters are delivered electronically via eMail and available on the OFF Website.