Print out the form and mail with a check to the address below.

Columbus Outdoor Pursuits  -  Membership Application

YES!   I want to become a member of Columbus Outdoor Pursuits.
I understand I will receive a full 12-month membership and all other benefits of membership.

Name: ____________________________________________________________

Address: __________________________________________________________

City: _________________________ State: ____________ Zip: ______________

Home Phone: (_____) ________________ Email: _________________________

Birth Date: _________________________ Previous Membership #: __________

Membership Type
___ Youth  ( 15 - 17 )

$ 15.00
___ Adult New Member  ( 18 - 54 )

$ 30.00
___ Adult Renewal   ( renewing within 3 months of last membership )

$ 25.00
___ Senior Citizen  ( 55 & over )

$ 20.00
___ Family

$ 45.00
___ Family Renewal   ( renewing within 3 months of last membership )

$ 35.00
___ Life $ 300.00
___ Organizational Membership   ( only for qualified groups ) .00
___ Replacement Membership Card

$ 1.00
___ Donation   ( tax deductible - specify amount ) ______.__
   

Total Amount Enclosed       

 $ ______.__
   

Activity Interests

Circle "1" for primary interests
and "2" for secondary interests.
Circle "3" if you are willing to lead trips.

Backpacking
Bicycling
Mt. Biking
Camping
Canoeing
Caving
X-C Skiing
Downhill Skiing		 1   2   3
1   2   3
1   2   3
1   2   3
1   2   3
1   2   3
1   2   3
1   2   3		   Hiking
In-line Skate
Kayaking
Sea Kayak
Rafting
Rock Climb
Other
 _________		 1   2   3
1   2   3
1   2   3
1   2   3
1   2   3
1   2   3
1   2   3
 

Volunteers

Columbus Outdoor Pursuits' success results from 
the willingness of many people to donate their time. 
We expect that our members will pitch in.  Please
check off the items below where you will help:

___ Mailing
___ Telephoning
___ TOSRV
___ GOBA
___ Bike tours - registration
___ Bike tours - sag
___ Bike tours - arrows
___ Bike tours - food stops		   ___ Office (weekdays)
___ Publications
___ Publicity
___ Data entry
___ Computer support
___ Trip Leader
        (training provided)
        Activity?_______

Make check payable to:  Columbus Outdoor Pursuits

Mail to:  Columbus Outdoor Pursuits, 1525 Bethel Rd Ste 100, Columbus OH 43220-2054

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