Hadeland Lag Membership Renewal Form

Make your check out to the Hadeland Lag and mail it with this form to:

Barb Schmitt, Treasurer               In Norway, mail payment to

1006 Aston Circle                        Harald Hvattum

Burnsville MN   55337                 Achimslinna 4, 2760 Brandbu


 

 Membership Information

Name

 

Mailing Address

 

City                                  State/Province      Zip/Postal Code  

 

 

E-mail ______________________________________

 

Phone (___)______-_________

 

DUES RATES  
US
    One Year    $15.00 USD
    Two Years     25.00 USD
    Three Years: 35.00 USD
Canada                                                                      AMOUNT ENCLOSED:  __________________
    One Year    $18.00 CAN
    Two Years     27.00 CAN
    Three Years: 38.00 CAN
International                                                             ___ Check Here if paid on-line  
     One Year   $ 25.00 US
     Two Years    45.00 US
     Three Years  55.00 US
Norway 
    One Year       100 NOK
    Two Years      200 NOK
    Three Years   300 NOK