INTERNATIONAL WILD RICE ASSOCIATION

2007 MEMBERSHIP FORM 

Business Name:___________________________________________________ 

Individual Name:__________________________________________________ 

Address:__________________________________________________________ 

City/State/Zip Code:________________________________________________ 

Telephone No.: ________________________Fax No.:_______________________ 

E-mail Address:_________________________

Fill out all above information.  Do not leave blank, specify none if not applicable. 

Membership Fee:  $150.00 Full Voting 

Associate Fee:            75.00 Nonvoting (not available to people in rice industry) 

Please accept my membership in the International Wild Rice Association.  My fee is enclosed. 

Fee Enclosed      $_________________   Membership Full Voting_______ 

                             $_________________   Associate Nonvoting____________

 Thank you for your support of our industry and association.  

Please mail with appropriate fees  to: