MEMBERSHIP APPLICATION 

MEMBER NUMBER______________________________    

Date of Membership: ______________________________ 

Date Expires:_____________________________________ 

ID Confirmation: Y/N Application Name Same as ID Name: Y  N 

Birthdate from ID: _________________________________  

State of ID Issue: __________________________________ 
=====================================================================

PLEASE PRINT 

Full Name: ____________________________________________________________________ 
Name to Use:___________________________________________________________________ 
 
Address:______________________________________________________________________ 

City:_______________________ State:________ ZIP:____________ County:______________ 

 
Phone: _(_____)______________ Email: ____________________________________________ 

 

I would like to be notified of events etc by e-mail. Yes:____________ No:_________________ 

 

Email Address:_________________________________________________________________ 

Do you have any health problems or instructions you would like us to know?   

______________________________________________________________________________ 

Signed:_______________________________________________________________________ 
 
Release Form...Please fill out both the membership and release forms and bring with you.