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Sign
up and be a Member of the Buckaroo Hall of Fame
Application for Annual Membership
Date:____________________
Name:________________________________________
Address:____________________________________________________________
City:__________________________ State:________________ Zip:_____________
Telephone:_____________________________________
Institution:_____________________________________
Title:__________________________________________
Amount of Contribution:
___Senior and Youth ($5)
___Institution($25)
___Sponsor ($1000-$25,000)
___Individual ($10)
___Contributing ($50-$950)
___Family ($20)
___Life ($1000)
Please print out and send check or money order to:
Buckaroo Hall of Fame
C/O Carl F. Hammond
30744 Culp Lane
Burns, Oregon 97720
or email info to:hdhammond@centurytel.net
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