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Membership app SCI OSC 040711 MJM
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* Phone 405-703-3381 * Fax 405-735-9537
Membership Application
Safari Club International - Oklahoma Station Chapter
[see separate form for Lifetime Chapter Membership]
Name: Address:
City, State: Zip Code:
Home Phone
: (
)
Cell Phone:
(
)
E-Mail:________________________________________________________
@____
____
___________________
____________
Day/Office Phone: ( ) FAX: ( ) Pager:
(
)
__________________
Other Phone:
(
)
________________ Web Site: _________________________________________________________
or specify________________:
________________________________________________________________________________________________________
Signature: _________________________________________________
: ________________________________
_______________________
Check One:
_____
Yes, I support the Safari Club International's and the Oklahoma Station Chapter's goals of
conserving wildlife and protecting the hunter. Please enroll me as a chapter and national
member for
$95.00.
I realize that my membership fees include a
$30 chapter membership.
The
national membership fee of $65
includes an annual subscription to the monthly
Safari Times
newspaper and bimonthly magazine,
The Journal of Safari Big Game Hunting.
_____Yes, I support the Safari Club International's and the Oklahoma Station Chapter's goals of
conserving wildlife and protecting the hunter. Please enroll me as a
chapter member
for
$30.00
I
understand that to enroll as a chapter member, I first must be a member in good standing of Safari
Club International. My
SCI Membership number is:
_______________________
OTHER SCI MEMBERSHIP OPTIONS
(Check One)
Annual
____ $ 65 (USA, Canada, Mexico) ____$ 90 (all other countries)
Three-year
____$ 150 (USA, Canada, Mexico) ____$ 225 (all other countries)
Life Member
____$1,500 (USA, Canada, Mexico) ____$2,000 (all other countries)
Senior Life (60 Years old +)
____$1,250 (USA, Canada, Mexico) ____$1,750 (all other countries)
Spousal Life
____$ 750 (USA, Canada, Mexico, all other countries) [no publications]
PAYMENT OPTIONS: Authorized Amount: _______________ ________Check (Make check payable to SCI)
____Visa____ MC Card Account #: ___
_______
_______________________ 3 Digit # on Reverse side of card________
(Absolutely necessary)
Expires: _____________
_______
Cardholder signature ___________________________________
Reminder: We cannot process your credit-card order without the expiration date & 3-Digit #
Please return this form with the appropriate fees to:
Dennis Elliott, MembershipChairman
9642 S. Quebec Ave., Tulsa, Ok. 74137
Email
* Phone 918-298-8299 * Fax 918-298-3013
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