MEMBERSHIP APPLICATION  2009-2010

Please mail to:  SCRANTON SKI CLUB
                        ATTN:  MEMBERSHIP
          PO BOX 3301
                          SCRANTON, PA  18505

Please Print Clearly

NAME _____________________________________________________________DOB________________
Please Note:  All members must be 21 years of age to join.

IF FAMILY, 2ND NAME______________________________________________ DOB________________
Family Membership is defined as two members residing at the same address.

ADDRESS_____________________________________CITY_________________STATE_____ZIP______

HOME TELEPHONE_______________________    WORK TELEPHONE_________________________

Do you want your telephone number published on the Club Membership Roster?

          HOME:     Yes_____     No_____     WORK:     Yes_____     No_____

EMAIL ADDRESS (print)__________________________________________________________________

Do you want your email address published on the Club Roster?      Yes_____     No_____

Are you a Skier?     Yes_____     No_____

NEW:  SINGLE $20 ______ (includes new member $5 initiation fee)      FAMILY $30 _______

RENEWAL:     SINGLE $15 _________          FAMILY $25 _________