Application for Membership in Smokey Bear’s Hometown Association

Name________________________________________             Date__________________

Mailing Address___________________________________ City_________________________

State___ZIP_________

Phonenumber_____________________        Email___________________________________                                                                                               

Membership: 

              Charter life member $100.00 _______                                   

OR

               Annual                               

Individual     $ 25.00 ________                 Family          $ 50.00 ________             Senior (62+) $10.00  ________

Suggested projects:_________________________________________________________________________

Contact Marilyn Hansen 505-354-3392 if you have questions.

Send checks payable to: Smokey Bear’s Hometown Assoc. PO Box 223, Capitan, NM 88316