MEMBERSHIP
APPLICATION 2011-2012
SCRANTON SKI
CLUB
ATTN: MEMBERSHIP
PO BOX 3301
SCRANTON,
PA 18505
PRINT CLEARLY
NAME_________________________________________________
DOB__________________
ALL MEMBERS MUST BE 21 YEARS OF
AGE TO JOIN.
IF
FAMILY, 2ND NAME___________________________________DOB_________________
FAMILY MEMBERSHIP IS 2 MEMBERS
RESIDING AT THE SAME ADDRESS.
ADDRESS_____________________________________CITY__________ST____
ZIP______
PHONE_________________________________
Do
you want your phone listed on the Roster? Yes ________ No________
EMAIL_________________________________________
Do
you want your email listed on the Roster? Yes________ No________
NEW: SINGLE $20 ________ FAMILY $30 ________ (includes new member $5 fee)
RENEWAL: SINGLE $15 _________ FAMILY $25 _________
SIGNATURE_________________________________________________
DATE__________
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