MISSOURI HUNTER EDUCATION INSTRUCTOR’S ASSOCIATION

Membership and Renewal Application
www.mohuntered.com
Please Print Clearly:

Name ____________________________Date ___________________

Street/Route_______________________________________________

City ______________State ______ Zip (+4) __________ + __________

County ___________________ MDC Region _____________________

Mo. Dept. of Conservation Hunter Education Instructor No. _________
or check here if NEW Instructor ___

Home Phone  ( _____ ) _______ - _____________
Email address?_____________________________________________
                       May we publish in newsletter?  ___ Yes  ___ No
Bowhunter Education Instructor Certified by MDC?  ___ Yes  ___ No

Membership Dues
(check only one)  
 ___ $10 Regular Instructor (Voting)
___ $25 Sustaining Instructor (Voting)
___ $200 Regular Life (Voting)
___ $10 Associate (Non-voting) MDC, DNR personnel
___ $25 Sustaining Associate (Non-voting)
___ $200 Associate Life (Non-voting)
___ $10 Auxiliary (Non-voting, non-instructor)
___ $25 Sustaining Auxiliary (Non-voting, non-instructor)
___ $200 Auxiliary Life (Non-voting, non-instructor)
___ $25 Affiliate, business or organization of like purpose
___ $300 Corporate
___ New    ___ Renewal   ___ Change of Address
Make check payable to:  M.H.E.I.A. 
Mail to: MHEIA, P.O. Box 4505, Springfield, MO  65808.