Membership Form

NAME: _______________________________________________________

ADDRESS: _____________________________________________________

CITY: ________________________________________________________

STATE: ___________ ZIP: ____________

HOME PHONE: ________ ________ ___________

CELL PHONE: ________ ________ ___________

SPOUSE’S NAME: ______________________

EMAIL: ______________________________________________

SCALES: G , O, On30, S, HO, N, and Z

LAYOUT: YES ________ NO ____ PLANNED ____ NONE _____

MEMBERSHIP TYPE:

Regular: $35 ___ Family: $40 ____ Associate: [age 18-21] $25 ____
Junior [age 12-18]: $15 ____ Initial one-time maintenance fee: $25 ____


How did you first hear about the Club? ________________________________________________________________________________________________________________________