Please print this application and send to the LRSA
Yes, I want to support the outstanding effort to restore, revitalize and restock the magnificent Lehigh River.
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Name__________________________________

Address_____________________________________

City____________________________________ State______ Zip_______

Phone___________________ Email_______________________

Please inform us: New________ Renewal________ Current________

Merchandise Only:________ Deduct $15.00 from price...

* Basic Sponsorship is: $15.00________ Decal (circle): Yes / No

* Silver Sponsorship is: $30.00 ________ You will receive a LRSA T-shirt! Indicate size (S,M,L,XL,XXL,XXXL) __________ Decal (circle): Yes / No

* Gold Sponsorship is: $35.00 ________ You will receive a LRSA Camo Hat! Decal (circle): Yes / No

* Platinum Sponsorship is: $50.00 ________ You will receive a LRSA Sweatshirt________  OR LRSA Camo Hat & T-shirt________ Indicate size (S,M,L,XL,XXL,XXXL)__________ Decal (circle): Yes / No

* Conservation Sponsorship (Catch and Release) is $50.00 ________ Receive a Special LRSA Hat.

* Diamond Sponsorship is $100.00 ________ Receive a Sterling Silver Wrap Around Trout Ring.

*All of the above include: Semi-Annual Newsletter, Badge (pin), Card and Decal.

LRSA Decal: $1.50 _________ Note: Included with membership!

LIMITED EDITION LRSA PATCH
The LRSA is proud to offer a limited edition patch featuring a rainbow trout.
Qty: _________
$5 plus $1 S&H = $6 Orders of 3 to 6 add an additional $1 for S&H

Lehigh River Conservation Fund (Donation Clean Water Fund)____________dollars

Enclosed is my check or money order for____________dollars. (The LRSA is a Non-Profit Organization 501-C3)

Please remit to: Lehigh River Stocking Association PO Box 54 Walnutport, PA 18088
I promise to obey all state fishing laws and rules of the Lehigh River Stocking Association, return my fish unharmed and only keep the fish I intend to consume.

Signature___________________________________________ Date___________________

Please print this application and send to the LRSA