NORTH CAROLINA WILDLIFE FEDERATION
			Application for Affiliate Organization
						Date _____________________
Name of Affiliate _________________________________________________________________
Mailing Address _________________________________________________________________
_________________________________________________________________
	Name		Address		Phone		eMail Address
President
Vice Pres.
Secretary
Treasurer
Other
Number of members in your club _________
	Less than 100 members, annual affiliation dues of $50 (enclosed)
	100 to 200 members, annual affiliation dues of $100 (enclosed)
	More than 200 members, annual affiliation dues of $150 (enclosed)
Club meets (frequency) _______ on (usual date or days of month) ________________________
Club year runs from ____________ to _____________
Is club interested in land use and environmental quality?   Yes ____  No ____
Is club interested in conservation of wildlife and habitat enhancement?   Yes ____  No ____
Is club interested in conservation of fisheries and habitat enhancement?   Yes ____  No ____
Is club interested in conservation education and programs?   Yes ____  No ____
Is your club interest limited to a specific theme?   Yes ____  No ____
If yes, what theme? ______________________________________________________________
_______________________________________________________________________________
Please list other groups with which your club is affiliated ________________________________
_______________________________________________________________________________
				Signed _____________________________________
	FOR NCWF OFFICE USE
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Mail to:	NCWF Affiliate Processing			NCWF District Number ___			Club Number _____
	2155 McClintock Rd.
	Charlotte, NC 28205			Approved by _________________________________
	(704) 332-5696