Membership Application

Circle One: New Renewal

Name	__________________________________________________
Drivers License Number	__________________________________________________
Date of Birth	__________________________________________________
Address	__________________________________________________
City, State, Zip	__________________________________________________
Telephone Number	__________________________________________________
Next of Kin	__________________________________________________
Address	__________________________________________________
City, State, Zip	__________________________________________________
Telephone Number	__________________________________________________
Employer	__________________________________________________
Business Telephone	__________________________________________________
Sponsored to the Club By (Give two Club Members Names):	__________________________________________________ __________________________________________________
List the names of any other organizations you belong to:	__________________________________________________

Conditions of Membership:
1. Minimum of 5 hours of service to club per year or $20 penalty.
2. No alcohol or self-induced intoxicants on club property.

ALL APPLICATIONS WILL BE VOTED UPON AT CLUB MEETING AND NOTIFIED OF CLUB ACCEPTANCE.