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PLEASE CHECK ONE OF THE FOLLOWING:
NEW MEMBERSHIP: $30.00 PER YEAR CASH: CHECK:
RENEWAL MEMBERSHIP: $25.00 PER YEAR CASH: CHECK:

PERSONAL INFORMATION:

LAST NAME: FIRST NAME or INITIAL: MIDDLE NAME or INITIAL:

ADDRESS:
CITY: STATE: ZIP CODE:
HOME PHONE: CELL PHONE:
E-MAIL:
(e-mail address could be published in the Newsletter)

BIRTHDAY DATE:MONTH DAY PLACE OF BIRTH:
BUSINESS AFFILATION:
ADDRESS:

BACKGROUND INFORMATION (include hobbies,special interest, family)


WE ARE A VOLUNTEER CLUB. PLEASE INDICATE IF YOU WOULD WORK WITH ONE OR MORE OF THESE COMMITTEES:          
MEMBERSHIP  WAYS & MEANS PUBLICATION ACTIVITIES HOSPITALITY/SUNSHINE PARTY

SPONSORING MEMBERS NAME:
(Please Print The Name)
SPONSORING MEMBERS SIGNATURE:
DATE OF SPONSORING MEMBERS SIGNATURE:

THE SPONSOR MUST BE PRESENT AT THE READING OF THE APPLICATION. IF NOT,THE APPLICATION PROCESS WILL BE TABLED UNTIL THE SPONSOR CAN BE PRESENT TO SUPPORT THE APPLICATION. (POLICY ADOPTED JANUARY 9, 2000)

MEMBERSHIP MEETINGS ARE HELD AT 6:00 P.M. THE SECOND SUNDAY OF EACH MONTH AT:
ATTITUDES PUB & GRILLE, 32 SHORELINE DRIVE, RIVER BEND, NC

  

Last Updated: May 04, 2011