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LINE CREEK CIVITAN CLUB
Peachtree City, Georgia
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membership application
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meetings:
1st & 3rd thursdays @ 6:30pm
first presbyterian church
206
willowbend road
peachtree city, ga
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Name___________________________________________________________________Nickname________________________________
Title____________________________________________________________________________________________________________
Business_________________________________________________________________________________________________________
Address
_________________________________________________________________________________________________________
City ____________________________________________________________________________________________________________
State/Province _______________ZIP/Postal Code_________________
Telephone (B)(____)___________(R)(___)___________________
FAX (______)_________________
Email Address______________________________________________________________________
Sponsoring
Civitan_________________________________________________________________________________________________
Spouse's name___________________Children___________________________________________________________________________
College/University (for students)___________________________Other
organizations and civic activities____________________________
_________________________________________________________________________________________________________________
Please circle your
special interest areas for Civitan Club work: Budget/Finance Newsletter Awards; Fund
Raising , Community Projects , Youth Work; Fellowship/Attendance Programs
Scholarships; Social Activities; Membership Growth; Special Olympics; Publicity; New Club Building; or Junior Civitan; Other
(specify)____________________________________________________________________
I hereby request membership in this
Civitan club. Upon acceptance, I agree to be subject to its constitution,
Bylaws, and official policies. I agree to pay the sum of $25.00 as an
initiation fee and the regular dues ($60.00 per quarter – includes meeting
meals) to the club, district, and Civitan International as billed by the
club. I understand that $2 of my annual dues shall be applied as a subscription
to Civitan Magazine.
Applicant's
Signature_________________________________________________________
Date_______________________________
For Transfers From other Civitan Club and Reinstatements Only:
Former Civitan Club
________________________Address______________________________________________________________
CLUB APPROVAL SIGNATURES
Membership Chair: ___________________________________________________________
Date______________________________
President:
: ___________________________________________________________________Date______________________________
Secretary :
___________________________________________________________________ Date_______________________________
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