TAMPA BAY GAMING ASSOCIATION

MEMBERSHIP FORM

 

Complete and return the form below with your check (made out to: David Glenn)

or a money order (cash only in person) to:

 

TBGA, P.O. Box 4792, Seminole, FL  33775    

 

Dues for membership are:

            1-year membership, paid August 31^st, 2004 or later (expires 8-31-2005):       $10.00

           

 

 

 

 

 

 

Please choose type of membership (choose one): [   ] Active  [   ] Gift

Name:________________________________________________________________________                                                                                                                                                                                         

Address:______________________________________________________________________                                                                                                                                                             

City:____________________ State:_________________ Zip Code: _____________________                                        

E-mail Address:_________________________________ Phone No: _____________________                                                                                                                                         

Date of Birth:____________________ Years of gaming Experience:_______________________                                                          

Days and times you can play:______________________________________________________                                                                                                                                                                                                                                                                                       

Types of games you enjoy playing (Be specific): _____________________________________                                                                                                                                   

 _____________________________________________________________________________                                                                                                                                                                      

Types of games you would like to learn (Be specific):___________________________________                                                                           

 _____________________________________________________________________________                                                                                                                                                                     

Games you would be interested in running or organizing:________________________________                                                                             

 _____________________________________________________________________________                                                                                                                                                                   

How much notice would you need before a game session?

[  ] 3 seconds               [  ] 1 day                      [  ] 2-6 days

[  ] 1-4 weeks              [  ] 1 month                  [  ] 1 year or you’re deceased

Would you need transportation to gaming sessions? [  ] Yes!  [  ] No!

Could you provide transportation to someone who needs it?  [  ]Yes!  [  ]No!

Name of TBGA member who referred you to us: ______________________________________

(Eligible for the TBGA Incentive Point Program <TIPS> )

 

All TBGA members will be listed with their names, phone numbers, e-mail, and games they play on a regular basis. 

This list will only be given out to the other TBGA members and revised periodically.  All other membership

information will be kept confidential and will never be sold or released to other parties.  All members agree to abide

by the rules and regulations (present and future) of the TBGA constitution.

 

x _________________________________                                                                                                            

 

Staff use only:   

 

Date Received:                 Amount:  $              Type: cash  check  m/o   Card Issued:  yes / no