Membership Application
Membership Type: _____ Individual $7.50 _____ Family $10.00
Name(s): ___________________________________________________________
Address: ___________________________________________________________
City: _________________________________ State: ________ Zip: _________
Phone Number: ______________________________________________________
Home Email: ________________________________________________________
Work Email: ________________________________________________________
Make checks payable to: BPCA. Memberships can be sent to the BPCA Secretary at the following address or can be brought to a BPCA meeting:
Steven Anderson
BPCA Secretary
1014 Canary Ln
Onalaska, WI 54650