Name

Date

Mailing Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Club Membership Fees for the 2024-2025 season are as follows: *

$25 for an Individual Membership - Persons 18+ years old

$25 for a Family Membership, which includes 2 adults living together, 18+ and any individual(s) 16 & 17 years of age

$30 for a Business Membership.

Designated individual

Name of Business

Address

Phone

$10 for an Affiliate Membership.

Please indicate your Primary Club