Iowa Hunter Education Instructor
Association
Membership Form
Name:
________________________________________________________________________
(Please Print Neatly)
Address:
______________________________________________________________________
Street
City
State
Zip
County: ____________________________
Telephone: _(_________)____________________
(Area Code)
DNR District Number: ____
NEW 5 RENEWAL 5 E-Mail Address: ________________________________________
If new member,
Please check one: ____ Member – Instructor Number _________________________
____ Associate Member
____ DNR Law Enforcement
____ Apprentice Instructor
____ Other ____________________________________________
Signature: __________________________________________ Date:
____________________
Make $10.00 check payable to: Iowa Hunter Education Instructor Association (IHEIA)
Mail To: IHEIA
PO Box 854
Des Moines, IA 50304
Note: My Change of Address: 5