Membership Enrollment Form

Full Name:*
DOB*
Address:*
City:*
State:*
Zipcode:*
Phone:*
Date Retired:*
Retired From:*
Spoues Name:*
Email:*
Make Check payable to 4-Unit C.O.R.F. for dues in the amount of $25.00, plus any other options selected and Mail to: Jerry Mason, 5896 Bretton Pl. Westerville, Oh 43082
(By using this application you do not have to pay any other dues)

               Include a self addressed stamped envelope to receive purchased Decals or your Membership card.

 
4-Unit dues- – C.O. R. F. 5.00
State dues——P. F. R O. 20.00
Donation to 4-Unit News
Decals 4-Unit 1.00
Decals State P.F.R.O. 1.00
Buy A Roster 5.00
TOTAL PAID:

**Our dues are due each year by January 1st. Be sure to fill in all the information requested, as it is all important. **

 Non renewal after 2 years will result in being removed from the 4 Unit News and roster mailing list.