National Animal Damage Control Association

Membership Application

Date: ____________________

Name:_________________________________________

Address:______________________________

City________________ State______ Zip: (9 digit) ________________

Phone: ( ______ )_______ - ___________ Office

Phone: ( ______ )_______ - ___________ Home

Dues: $ ___________ Donation: $ _________Total: $ ______________

Membership Class (circle one): Student-$10.00 Active-$20.00 Sponsor-$40.00 Patron-$100.00

Make Check or Money Order payable to NADCA

Mail to: Art Smith, Dept. of Game, Fish & Parks, 523 E. Capitol Ave., Pierre, SD 57501

• Agriculture
• State Agency
• Nuisance Wildlife Control Operator
• Pest Control Operator
• Trapper
• USDA-APHIS-WS
• Extension Service
• Equipment/Supplies
• University
• Federal - not APHIS or Extension
• Retired
• Foreign
• Other (describe) __________

May 26, 2005