Michigan Chapter of the American Fisheries Society
Membership Application or Change of Address Notice

Annual dues are $5.00, made payable to "Michigan Chapter, AFS".

Please send dues and completed form to:

Name:________________________________________________________________________

Are you retired? ______Yes ______No

Are you a member of the Parent Society? _____Yes ______No

Member Type: ______Regular ______Student

Company/Agency: ______________________________________________________________

Department/Division: ____________________________________________________________

Station/Office: _________________________________________________________________

Address: ______Work ______Home

______________________________________________________________________________

______________________________________________________________________________

City: _____________________________ State:______________  ZIP Code: ___________ 

Telephone: ______Work ______ Home    Number: (_____)_________________  Extension: ________

Fax  : ______Work ______ Home    Number: (_____)_________________

Email (please print clearly):_______________________________________