First Name Last Name Home Phone
Home Address
City Country
State/Province Postal Zip Code E-mail
Conservation Agency
Position Still Active?
What region do you work in?
Is this a new Membership or a Renewal?
Check this box if the membership is for Associate Membership (Updated 07/12/06)

All memberships expire December 31.

Item   Cost

X
Regular Membership (WCO or DWCO)

$15.00
Regular Lifetime Membership (active WCO or DWCO) $200.00
Regular Retired Lifetime Membership (retired WCO, DWCO) $100.00
Associate Membership $10.00
Associate Lifetime Membership $100.00
Junior Associate Membership (ages 16 and under) $5.00
Payment Information
Check Number
Money Order #
Amount Enclosed

Date Received:                        Date Mailed:                       

Print out and mail with appropriate payment by check or money order to:

COPA
PO Box 345
Huntingdon PA 16652-0345        Return to Membership Information