MEMBERSHIP APPLICATION

Please mail your completed application, along with a check or money order made payable to the Northeast Ursamen, Inc., Post Office Box 2042, Hartford, CT, 06145-2042.

FOR BEAR 1:

Name (required):_________________________________________________________________

E-Mail Address (optional):__________________________________________________________

Nickname (optional):______________________________________________________________

Birthday (optional): _______________________________________________________________

Name Tag Inscription (Up to 20 characters or spaces): __________________________________

Is it OK to post photos of you at club events on our website? _____________________________

FOR BEAR 2:

Name (required, if applicable):______________________________________________________

E-Mail Address (optional):__________________________________________________________

Nickname (optional):______________________________________________________________

Birthday (optional): _______________________________________________________________

Name Tag Inscription (Up to 20 characters or spaces): __________________________________

Is it OK to post photos of you at club events on our website? _____________________________

FOR EVERYONE:

Address (required):_______________________________________________________________

City, State, Zip Code:______________________________________________________________

Area Code / Telephone Number (optional): ____________________________________________

Hobbies (optional):________________________________________________________________

I (we) agree to abide to the Bylaws of the Northeast Ursamen (available upon request), and attest to being over 21 years of age.

Signature 1 (required): X ____________________________________________________

Signature 2 (required, if applicable): X _________________________________________

Website and all contents are copyrighted © 1993, 2006 Northeast Ursamen, Inc. All Rights Reserved.