AzOTC logo AzOTC Membership Application

Please fill out the form     starred * items are required.
Note: for change of address use this form: Change Address
- $25 (Single or parent w/ children)
- $40 (Married couples incl. children)
 
The annual membership fee is due on September 30th each year, good through September 30th the following year, and is pro-rated as follows:
Join Date Individual Membership Family Membership
Prior to 12/31 $25.00 $40.00
1/1 to 3/31 $18.75 $30.00
4/1 to 6/30 $12.50 $20.00
7/1 to 8/31 $ 6.25 $10.00
Note: A monthly newsletter in PDF format will be emailed out each month. A valid email address must be provided. Your email address will only be used for club businesss and will never be rented or sold! 
Unblock dgmowry@gmail.com  from any spam filters to allow your newsletter to get to you!

Please provide the following member information and any information that may have changed:

Fill Column For All Membership Types

For Family Memberships Only: Spouse
First Name* Spouse First Name
Middle Initial Spouse M.I.
Last Name*
Gender*    
Marital Status
# Children Under 18
Street Address*  
Address (cont.)
City*  
State/Province*  
Zip/Postal Code*

Spouse

  
Age Group Age Group
Home Phone* - -
E-mail*   E-mail
Work Phone --

Work Phone

--

Include me in Club Directory (click "No" to be excluded): Yes  No

By checking the following box you are maintaining that: "I/We intending to be legally bound members of the Arizona Outdoors and Travel Club™ (AzOTC); do hereby, for myself, my family, and my heirs release all rights and claims for personal injuries or damages I/we incur while participating in AzOTC-sponsored activities.

I/We agree to the waiver liability stipulation above: Agree

How did you find out about AzOTC? Website Family or Friends  Newsletter
Other: __________________________________

Copyright © 1999 Arizona Outdoor Travel Club. All rights reserved.
Revised: July 25, 2010