Association of Great Lakes Outdoor Writers
Application for New Active, Associate, Student Memberships
_________________________________________________________________________________________________
MAIL TO:
NEW MEMBERSHIP DUES
Jan. l to June 30
After June 30
AGLOW
NOTE: Includes Dues for 1-1/2 years
Curt Hicken, Executive Director
( ) Active $75
( ) $112.50
P. O. Box 35
( ) Associate $75
( ) $112.50
Benld, IL 62009
( ) Student $45
Enclose Check Payable To: AGLOW TOTAL AMOUNT $_________
_________________________________________________________________________________________________
I have read the principles and membership requirements of the Association of Great Lakes Outdoor Writers
(AGLOW) and wish to apply for membership in the classification noted above. Current dues and fees are enclosed.
I pledge to voluntary ask for change of classification or for withdrawal from the organization should I fail to meet
the standards in the future. I also understand that my classification will be substantiated each year through my
Membership Directory listing data. I understand that one-third of AGLOW's membership is
audited annually.
Name: ____________________________________________________________________________________
Employer: _________________________________________ Position: ________________________________
Business Address: ______________________________________________Phone: _______________________
City: ______________________ State: ______ ZIP (plus 4 digits) ______ Fax: _________________________
Home Address: ____________________________________________ Phone: ___________________________
City: ___________________ State: ______ ZIP (plus 4 digits):______ E-Mail:__________________________
Please send AGLOW mail to: ( ) Business ( ) Home
Spouse's First Name:________________________
QUALIFICATIONS (Check all that apply)
My communications work is: ( ) Full-time ( ) Part-time.
I work in the field(s) checked below:
( ) Newspaper
( ) Magazine
( ) Photography
( ) Radio
( ) Television
( ) Lectures
( ) Books
( ) Trade Journals
( ) Teaching
( ) Public Relations
( ) Gov. Info-Ed
( ) Artist
( ) Other (specify): _______________________________________
I certify that I am PAID for my outdoor communications work and my work is published or disseminated:
( ) daily, ( ) weekly, ( ) monthly or ( ) times a year.
I have COMPLETELY filled out this application, ENCLOSED my check and I HAVE INCLUDED samples and/or other PROOF
OF MY WORK (newspaper clips, letter from station manager attesting to frequency of radio/TV broadcasts, lecture
schedule or public clips or art prints, masthead(s) of journal(s) showing position on staff) or any other evidence as
required. I understand that Member status is subject to Board of Director's approval.
Applicant Signature _________________________________ Date ______________
AGLOW Member - Sponsor (Print) ___________________________________________