NAME: _______________________________________________________
ADDRESS: _____________________________________________________
CITY: ________________________________________________________
STATE: ___________ ZIP: ____________
HOME PHONE: ________ ________ ___________
CELL PHONE: ________ ________ ___________
SPOUSE’S NAME: ______________________
EMAIL: ______________________________________________
SCALES: G , O, S, HO, On30, N, and Z
LAYOUT: YES ________ NO ____ PLANNED ____ NONE _____
MEMBERSHIP TYPE:
Regular: $35 ___ Family: $40 ____ Associate [ages 18-21]: $25 ____
Junior [ages 12-17]: $15 ____ Initial one-time maintenance fee: $25 ____
How did you first hear about the Club? ____________________________________________________________________________________________________________________