HRB&TS   Application for Membership

Name       ______________________________________________________________

 Address  ______________________________________________________________

                ______________________________________________________________

                ______________________________________________________________

 Phone     ____________________

 Email      ____________________

                 (Newsletters will be emailed when an address is provided unless you request otherwise)

 May we publish the information on this application in a club roster?     YES     NO

 Are you a certified beer judge?     YES     NO

 Do you usually brew   .   .   .   .   ALL GRAIN     EXTRACT     BOTH

 Would you like to participate in club brewing sessions?     YES     NO

 Any comments?     _______________________________________________________

 Yearly dues are $15.00 per person or $20.00 per family. 

 Dues paid     $____________              Date: ______________

 Please make checks payable to HRBTS and mail to:

 Treasurer - HRBTS                              Phone:  (757) 408-7912
 4621 Hermitage Road                          Email:   sgman@exis.net
 Virginia Beach, VA   23455