Name (please print)_________________________________________

Address_________________________________________________

City, State, Zip_____________________________________________

Phone (daytime)___________________________________________

Phone (Evening)___________________________________________

E-Mail___________________________________________________

Make checks payable to:
Friends of the North Fork & White Rivers
PO Box 61, Mountain Home, AR 72654

Membership Levels - (Membership dues and any donations are tax-deductible)
□ Individual Annual Membership - $25.00
□ Family Annual Membership - $35.00
□ Partnership Annual Membership - $100.00
□ Life Membership - $500.00
□ Business/Organizational Membership - $50.00
□ Donation ($________) - Donations are appreciated!

White River Sections for Stream Teams (check one):
□ Dam / Wildcat Access      □ Cotter / Buffalo City       □ Buffalo City / Calico Rock    □ Calico Rock / Sylamore  
□ Sylamore / Guion   □ Guion / Batesville
□ North Fork River

□ I am willing to volunteer some time

 

Signature                                                                 Date: