-CHALLENGE THE OUTDOORS, INC. - MEMBERSHIP APPLICATION

NAME:______________________________________________________________________ ADDRESS: __________________________________________________________________

CITY: _____________________________________ STATE: _____ ZIP CODE: ___________ PHONE ____-_____-______ E-MAIL______________________________ TO RECEIVE THE NEWSLETTER

***THE DUES ARE TO BE PAID YEARLY IN THE SAME MONTH (EACH YEAR) THAT YOU JOINED***

CHECK ONE

_________One-Year Individual Membership--one person -----$20

_________ One-Year Family Membership------------------------$30

Adult(s) with children living at home ages 18 and under (if child is disabled, there is no age limit)

_________ Lifetime Individual Membership--one person------$100

_________Lifetime Family Membership ----------------------------$150

Adult(s) with children living at home ages 18 and under, (if child is disabled, there is no age limit) _________Sponsorship--------------------------------------------------$200

Allows any disabled person of the sponsor's choice, and an assistant (if needed), to attend any available CTO event.

PLEASE CHECK THE BOXES PERTAINING TO YOU:

________DISABLED PERSON ________NEW MEMBERSHIP

________VOLUNTEER ________RENEWAL MEMBERSHIP

IN THE FAMILY MEMBERSHIPS WITH CHILDREN—WE NEED ALL THE CHILDREN LIVING AT HOME (THAT ARE 18 YEARS OLD AND UNDER) LISTED BELOW – LIST THE CHILDREN’S NAMES, AGES, AND; IF ANY ARE DISABLED, PLEASE PUT A CHECK BY THEIR NAME.

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INTERESTS: Hunting____Fishing _____Volunteering_____Other_______________________

Dueto financial need, I request to be considered for a one year sponsored-single, disabled membership. Please explain reason: _______________________________________________

RETURN THIS FORM & THE DUES TO TO:CHALLENGE THE OUTDOORS, INC. HOME INSTEAD SENIOR CARE 901 ANDERSON DRIVE GREEN BAY, WI 54304

ADULT(S)-PLEASE SIGN HERE & PUT THE DATE AT TOP OF PAGE

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NOTE: BY SIGNING THIS APPLICATION, YOU ARE GIVING PERMISSION FOR US TO USE YOUR PICTURE(S) IN THE PLACES WE MENTION HERE. We take pictures at all our events for use in our organization's advertising, displays at events, our web page, in newspaper and magazine articles and in our brochure.-- All internet addresses and pictures are used by our organization, CHALLENGE THE OUTDOORS, INC., ONLY. We do not give out any e-mail addresses or pictures to anyone else.

CHECK OUT OUR WEBSITE AT www.ctoforme.org--Our office phone number is 920-593-6300