Print this form and mail it with your payment to the address at the bottom.

2009/2010 Membership Registration (due February 2010)

Name (please print or type)  __________________________________________________________

Occupation  ______________________________________________________________

Affiliation  _______________________________________________________________ (Jurisdiction, organization, company, etc.)

Mailing Address   __________________________________________________________                         __________________________________________________________

Phone _________________________            E-mail address ______________________

Membership dues are $10.00 annually.   Mail completed application and check payable to W.W.C of I.C.C.

Send to:    David McCurdy, Treasurer W.W.C. of I.C.C. PO Box 11246 Tacoma, WA  98411

Questions contact David McCurdy at (253)798-7112 or Mike Noot at (253) 798-7218