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  • 2015 Mem-Ap

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    This document contains a membership application form for the Smoky Mountain Polish Specialty Club. It requests the applicant's name, address, city, state, zip code, ARBA number, birth date, phone number, email, additional family members' names, ARBA numbers and birth dates. It lists the types of available memberships including individual adult, two adults, individual youth, and family memberships for either 1 or 3 year terms. It requests payment information and provides contact information for the club secretary/treasurer to submit the completed form and payment.

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    2015 mem-ap

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    This document contains a membership application form for the Smoky Mountain Polish Specialty Club. It requests the applicant's name, address, city, state, zip code, ARBA number, birth date, phone number, email, additional family members' names, ARBA numbers and birth dates. It lists the types of available memberships including individual adult, two adults, individual youth, and family memberships for either 1 or 3 year terms. It requests payment information and provides contact information for the club secretary/treasurer to submit the completed form and payment.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    28 views1 page

    2015 Mem-Ap

    Uploaded by

    api-277296961
    This document contains a membership application form for the Smoky Mountain Polish Specialty Club. It requests the applicant's name, address, city, state, zip code, ARBA number, birth date, phone number, email, additional family members' names, ARBA numbers and birth dates. It lists the types of available memberships including individual adult, two adults, individual youth, and family memberships for either 1 or 3 year terms. It requests payment information and provides contact information for the club secretary/treasurer to submit the completed form and payment.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 1

    Name: ________________________________________________________________

    Address: ______________________________________________________________
    City _____________________________ State: _________ Zip Code: ______________
    ARBA #: _________________ Birth Date: _____/_____/_____
    Phone:____________________ E-mail Address: _______________________________
    Additional Family Members: (include youth birth dates)
    Name ARBA # Birth Date
    ______________________________________________________________________
    ______________________________________________________________________
    ______________________________________________________________________
    ______________________________________________________________________
    ______________________________________________________________________
    ______________________________________________________________________
    ______________________________________________________________________
    Type of Membership: New __ Renewal __ (Check all that apply)
    Individual Adult: __ 1 yr $10.00; __ 3 yrs $25.00
    Two Adults (same household): __ 1 yr $17.00; __ 3 yrs $46.00
    Individual Youth (through age 18): __ 1 yr $5.00; __ 3 yrs $12.00
    Family: __ 1 yr $25.00; __ 3 yrs $65.00
    Recommended by: _____________________________________________________
    Make check payable to Smoky Mountain Polish Specialty Club and send to:
    Roxanne Moore, SMPSC Secretary/Treasurer,
    155 White Laurel Ln., Covington, GA 30016 239-980-4955

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