Southeastern Game Rancher's Association

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Membership Renewal Application for the Southeastern Game Rancher’s Association (2010) First Name:  ____________________________________ Last Name:  _____________________________________ Farm/Business Name: ________________________________ Mailing Address:  _____________________________________ City:_______________________ State:_______ Zip Code:_________ Business Address:   _______________________________________ City:_______________________ State:_______ Zip Code:_________ Phone Number:    Day: ______________ Night:  __________________                              Other:______________________________________ Email Address:____________________________________________ Type Membership (Check One) _____Student Membership   $25.00 (Annually) _____Active Membership   $100.00 (Annually) _____Lifetime Membership $750.00 (One Time Payment) Payment Method: (Check One) _____Check _____Money Order Mail to: Dwayne Stringer Secretary/Treasurer 4147 Ruby Road Crystal Springs, MS 39059