Name_______________________________________________________________
Address____________________________________________________________
City________________________________________________________________
State and Zip_______________________________________________________
Phone_______________________________________________________________
E-mail______________________________________________________________
Age______________________ AMA #____________________

Dues for 2005
Junior (age 17 and Under) $15.00
Senior 18+$35.00
Family (Includes all AMA licensed members including
at least one adult of an immediate family) $45.00

Fill out and send to
Jayme Johnson
14257 Lowery Dr.
Little Falls, MN 56345