_____ Renewal _____ New Member

_____ Single ($15) _____ *Family ($20) *Family membership includes two adults and all children under the age of 18

Name(s) of Adult(s): ________________________________    ____________________________                                                                                                                    

Newsletter Preference (Check one)
_____via email or _____ via USPS

Number of Children under 18 _____

Mailing Address: ________________________________ 


Telephone Number: ________________________________

Email Address: ________________________________

$_________Dues $_________Newsletter via USPS Donation $_________Total Attached

Make checks payable to OCM&G Assoc.

Please print and bring the completed application and payment to a club meeting,

or mail to: Dennis Gross
178 N. Main Street
Bryant Pond, Me 04219

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