Missouri Renewable Energy Membership Application

NAME (please print clearly) ____________________________________________________

ADDRESS____________________________________________________________________

CITY/STATE/ZIP_______________________________________________________________

HOME PHONE _________________________________________________________________

EMAIL________________________________________________________________________

Membership fee:  $100 (1 year, 2 classes)

T-Shirt Size (circle one):  Med  Lrg  XLrg

Please make checks payable to: Missouri Renewable Energy

Payment by (circle one)   Visa    MasterCard

Credit Card # __________________________________________________________________

Exp. Date  _____________________________________________________________________

Cardholder’s Name ____________________________________________________________

Signature  _____________________________________________________________________

Mail to:

Missouri Renewable Energy

PO Box 2525

New Bloomfield, MO  65063 

Or Call to place your membership order: 1-800-228-5284