MEMBERSHIP STATUS:

NEW

RETURNING

MEMBER AS OF:

_________________
QUARTER / YEAR

YOUR NAME

LAST_____________________________________________________________________________________
FIRST ______________________________________________________ MIDDLE
______________________
DATE OF BIRTH __________________________
______________

PHONE #: ( ) _______ -

MONTH/DAY/YEAR

EMAIL ADDRESS
____________________________________________________________________________
EDUCATIONAL BACKGROUND
MAJOR _______________________________________________ CLASS _____________________
FRESHMAN/SOPHMORE/JUNIOR/SENIOR/SUPERSENIOR

INTRAMURAL SPORTS INTERESTED IN:

Flag Football
Soccer

Tennis

Volleyball

Basketball
COMMITTEES INTERESTED IN:
Spring Gala

Community Service

Film Festival

ISP

Pump House
HOW DID YOU HEAR ABOUT EWB?
_________________________________________________________
______________________________________________________________________________________
INTEREST ______________________________________________________________________________
______________________________________________________________________________________

PAYMENT METHOD MEMBERSHIP FEE IS $20.00 (INCLUDES FREE T-SHIRT) THEN $25 AFTER 2ND MEETING OF
THE QUARTER
CASH

CHECK

T-SHIRT SIZE:

SMALL

MEDIUM

LARGE

LARGE

SIGNATURE:

DATE:

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