Name: ____ _

Last First MI

Address: _______________________________________

street apt #

_________________________ _________ ___________

city/town state zip

Telephone: _____________________________________

daytime evening

Email: _ @ _________

Birthdate: ________/_/_______

Month Day Year

Applicants must be 18 years old or older

I will volunteer for:

____ Fund-raiser Committee Chairperson _____ Event Fund-raiser Committee Member

____ Product Fund-raiser Committee Member _____ Refreshment Committee Chairperson

____ Other(specify)______________________________________________________________________

Annual membership fee for all members is $10.00 a year. Initial $5.00 non-refundable deposit required at time of application with balance due no more than 60 days from the date of your welcome letter. Membership can be terminated anytime at the discretion of and by the Executive Board. Voluntary membership termination must be in writing and addressed to the Executive Board.

Applicant’s Signature_________________________________

(DO NOT WRITE BELOW THIS LINE)

Received________________________ By______________________ $5.00 deposit received?
Date Initials Yes / No

Membership card mailed________________________ By__________________________
Date Initials

Name: ____________________ ______________________ _______