Membership Application for the Outremer Society

(ONE application per person)

All sections must be completed:

Date of application: ____________________

Legal name: __________________________________________________

Mailing Address:

|___________________________

|___________________________

|___________________________

Telephone number (including area code): _____________________ Best time to call?_______________

Email address: __________________________________________

How did you hear about The Outremer Society? _________________________________

Membership Fees: check appropriate line

______FREE Basic Membership one year: Non-voting member

______$10 Contributing Membership one year: Includes voting rights and membership card

______$20 Sponsors Membership one year: Includes everything in a Contributers + More

$5 off to those with Studant IDs(include copy), $5 off for family members residing at the same address not comunitalive unless buying Sponsors membership)

Total enclosed: $ _______

If this is a family membership, send ALL applications in same envelope with ONE check or money order. PLEASE keep a copy of all paperwork for your records. Waiver(s) MUST be included with application(s) or it/they will not be processed.

Forms of payment accepted: (made payable to: “The Outremer Society”)

Personal check

Money order

Do NOT send cash!

Mail to: The Outremer Society

319 Yerger Drive

Bozeman, Montana 59718

USA

Please allow 2 to 4 weeks for processing of your application. You will receive a membership card and certificate in the mail if applicable.

Do NOT write below this line

-------------------------------------------------------------------------------------

Application received: ____________ Local Chapter: _________________________________

Waiver received: Yes ____ No ____ Membership Class: _______________________________________

Membership Number: _____________ Next fees due: ______________