USE ONLY TO PAY DUES FOR 2009

Do not use this form unless you are already a member of Mowogo Lodge
Please use the Transfer Request Form

              (Please Print / Write Clearly)

             $ 8.00 if current dues paid for 2008 with Mowogo Lodge
                    and money received before 1/1/2009

             $10.00 if current dues paid for 2008 with Mowogo Lodge
                    and money received after 12/31/2008
             $16.00 for all others    

             Please use separate form for each Arrowman     

NAME            _________________________________________

ADDRESS	        _________________________________________

CITY, ST ZIP    _________________________________________

PHONE           _________________	

e-MAIL          ______________________________________       (PLEASE PRINT)

Month, Day & Year of Birth   ____/____/____     UNIT   ________

CHAPTER (circle)   Ani-gatogewi   Canantutlaga   Japeechen   Jutaculla   Lau in nih   Machque   Yona-hi

Mail to:        Mowogo Lodge
                PO Box 80305                       ____ Check here if any information
                Athens, GA 30608-0305                      has changed

Visit    http://www.mowogo.org   and    http://www.mowogo.org/lodgereports/