2011 WNPF MEMBERSHIP
Name
__________________________________________________ Sex __________
Address
_______________________________________________________________
City _______________________________
State________ Zip code _______________
Telephone # ____________________________
Email ___________________________
Age_______ Date
of birth ____ ____ ____
Please check the following questions
I am an official with another organization?
Y__ N __
If yes, which organization? _________________ Your
officiating level is? ___________________
Please check one…..
I am lifetime drug free Y __ N __
I am 3 years minimum drug free Y__
N___
Signature
_______________________________
Date of your application ____________
Membership card fees
Youth- Under 12 years of age- $20.00,
Special Olympians- $20.00,
High school lifters- 13 to 19 with school
I.D. only- $20.00,
College Students- 20-23- $30.00,
Seniors- 65 years of age and older- $30.00,
Adults- 24 to 64 years of age- $40.00
All memberships expire on the first
day of the following year’s month.
Example: If you join on Feb. 26,
2011 your membership will expire on Feb. 1, 2012.
Send to: WNPF, POBOX 142347,
FAYETTEVILLE, GA. 30214
770 668-4841 OR
EMAIL Wnpf@aol.com