(One application per membership, PLEASE PRINT)

Name:
__________________________________________________________________

Address:
________________________________________________________________

Phone #:
________________________________________________________________

Number of years as a member of Alex Bealer : _______________

Number of meetings attended in the past 12 months: _________ (October 2017 to September 2018)

Minimum of 6 meetings attendance required – please indicate meetings attended:
ATTENDED Month Day Location
_____ October 2017 21 Ken Baker’s Elevator Shop
_____ November 2017 18 Red Top Mountain State Park
_____ December 2017 16 John Zeigler’s Forge
_____ January 2018 20 Goat and Hammer Forge
_____ February 2018 17 Tom Davenhall's Forge
_____ March 2018 17 Sean O'Shea's Forge
_____ April 2018 21 Tom Sheets' Forge
_____ May 2018 19 AACB Conference
_____ June 2018 16 Jim Guy's Forge
_____ July 2018 21 Mike LaMarre
_____ August 2018 18 Steve Fowler
_____ September 2018 15 Art Center West



I certify that I have met all of the qualifications to be awarded a scholarship by ABBA
and that I will fulfill the obligations that go along with accepting a scholarship in a
timely manner.

______________________________________________ (Signature)

__________DATE