Dyersburg/Dyer County Photography Club
Membership Application
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Date:____________________________

I hereby apply for membership in the Dyersburg/Dyer County Photography Club in the following Membership Category (check one box below):

___Individual – $40.00

___Dual Family – $60.00 (please submit one application per person)

___Student - $20.00 (age limit is 18)

Mr., Mrs., Ms. _____________________________________________________________________

Address________________________________________________________ Apt #____________

City_______________________________________________ State________ Zip______________

Home #______________________ Cell #______________________Work #___________________

E-Mail Address____________________________________________ I have no e-mail address_____

Personal Web Page URL: http://_______________________________________________________

Main photographic interests are (check all that apply and add any additional):

MEDIA FAVORITE SUBJECTS
__Film__Architectual__Portraits
__ Digital__Creative__Travel
__ Cityscapes__Landscapes
__ Nature__Photojournalism
__ Wildlife__Other

What programs, field trips or workshops, etc., would you like to see our club do or additional suggestions?

Amount Paid: $___________ Check No:___________ Cash:___________

Please make your check payable to the Dyer County Photography Club and bring it to the next meeting or mail with this application to the following address:

Dyersburg/Dyer County Photography Club

c/o Dennis Davin

808 Granite Dr.

Newbern, TN. 38059