NATIONAL SHOW ROLLER  ASSOCIATION

;National Show Roller Association  New Membership Information        Adult Member________    Junior Member________Age________        Name: ________________________        Address:_______________________________________________        Phone #:___________________ Cell:________________________        E-Mail:________________________________ Band Order: Bands are sold in 50 to 100 bands to a string. 50 bands @ $15.00 100 bands @ $30.00 Membership Dues are $20.00 for Adults and $10.00 for Juniors. Please make your check out to NSRA and send to: Sam Wesley 3709 Pepperell Pkwy Opelika, Al. 36801                                              Membership Dues $_______________                                                Band Order Circle one                                                                        50 or 100 $______________                                                                 TOTAL $_______________                                                                                  Thank You!