Long Island Wrestling Association

 

MEMBERSHIP APPLICATION
 January 1, 2019 to December 31, 2019

Name: _____________________________________________________________________

Street Address:______________________________City/Town________________________

County _____________________________State__________________ Zip______________

Home Phone__________________________Bus. Phone_____________________________

Wrestling Affiliation If Any______________________________________________________

E-mail Address______________________________________________________________

Membership is $25.00 Per Year.  Make Checks Payable to Long Island Wrestling Association, Inc.

Additional contributions beyond our $25.00 membership will be greatly appreciated!

Mail Your Check & Completed Membership Application to:

Long Island Wrestling Association, Inc.
117 Dale Dr
Oakdale, New York 11769