New Member Signup Form

WAzzuOR Raw Membership Application

To apply for membership please complete all fields.
Membership type*

New MembershipRenewal
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Has any of your contact info changed?
E-mail*
Home Number

Area CodePhone Number
Cellular Number*

Area CodePhone Number
Work Number (optional)

Area CodePhone Number
Membership Type (Dues are applicable for a calendar year and are non-refundable, non-transferable.)*

Non-Volunteer Member ($45 per year)
Total Due
Signature*
Signature date
Date Dues Paid

MonthDayYear
Payment Method

Pay Now Credit CardPay Now PayPalPay Later
Referred by, if applicable
How did you learn about WAzzuOR Raw, LLC*
If paying by check, mail to: WAzzuOR Raw
5420 226th St NW
Stanwood, WA 98292

To use Credit Card or PayPal, use Pay Here on our website (found under Enter Store)
Please allow 24 hours (after forms and dues have been submitted) for your membership to be processed.
Should be Empty:

WAzzuOR Raw Membership Application