ILLINOIS RIVER HRC MEMBERSHIP FORM
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SEND COMPLETED ILLINOIS RIVER HRC FORM AND CHECK TO:
Joy Plemmons
408 Willow
East Peoria, Il 61611
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Please print or type all information
NAME______________________________________
ADDRESS ____________________________________
CITY ____________________ STATE________________ ZIP _____________
PHONE (______) ____________________
E-MAIL ADDRESS______________________________________________________
DOGS CALL NAME ____________________________________________________
TITLES ______________ _______________ _______________
UKC POINTS ______________
FAMILY MEMBERS ___________ _____________ _______________
___________ _____________ _______________
DATE: _____________
FEE (Please Circle One) $20.00 Single Membership $25.00 Family Membership
MAKE CHECK PAYABLE TO: ILLINOIS RIVER, HRC CHECK #___________
HRC # ____________