Please Print, Fill out and Call 704-279-1214 for Instructions to Fax (9-5 Tues - Fri)

Or Mail to:

NCWaterman
PO Box 1345
Rockwell NC 28138

NC Waterman Membership Application

Name_______________________________________________________________

Address_____________________________________________________________

Home Phone_____________________Cell_________________________________

email Address________________________________________________________

NCWaterman User Name_______________________________________________

Membership Dues are:
(Check) Family Membership $35_____Individual Membership $25_______

You are Joining the Piedmont Chapter of NC Waterman - If you wish to join
a different chapter please check here________.

Please make your check payable to North CarolinaWaterman Piedmont.