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MEMBERSHIP APPLICATION 2009-2010 Please mail to: SCRANTON SKI CLUB Please Print Clearly NAME _____________________________________________________________DOB________________ IF FAMILY, 2ND NAME______________________________________________ DOB________________ 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 _________ |