BRODHEAD PIETENPOL ASSOCIATION
                                                                                    
                                       Membership Application
                                       
                                         Date ____________  New Member __________  Renewal __________
                                         
                                         1 year USA……………...$20.00
                                        
                                       2 year USA……………...$35.00          
                                         Back issues……………..$  4.00 (Indicate which issues)
                                        
                                       
                                        
                                       Outside USA:  For method of payment please email BPA
                                          1 year ............................$25.00
                                          2
                                       year ............................$45.00
                                        
                                       
                                         Name:                                                                                                         
                                        
                                        Address:                                                                                                     
                                       
                                        
                                         City:                                                                                                            
                                        
                                         State:                                                                       
                                       Zip:                            
                                        
                                         Phone:                                                                                                        
                                        
                                         Email:                                                                                                         
                                        
                                         Amount enclosed: _________________ 
                                                 (Cash/check
                                       only – no credit card)
                                        
                                         Make all checks payable to:  BPA or Brodhead Pietenpol Assoc. 
                                        
                                         All correspondence
                                       - including membership  payments, articles, 
                                         photos, letters,
                                       comments, suggestions, concerns, classified ads, etc., 
                                         should be mailed to:
                                        
                                          Brodhead Pietenpol Association
                                          2424 American Lane
                                          Madison,
                                       WI 53704
                                        
                                        Email:
                                       jhofmann@reesgroupinc.com
                                       Web:     pietenpols.org