SCCC Membership Application Form
Date ________________
Last name _______________________________________ First Name ________________________
Address __________________________________________________________________________
City ______________________________________ State _________ Zip __________ - __________
E-mail address _________________________________________
Telephone ______ -________ - ___________ Date of Birth _____ /_______ / _______
Type of Membership: Check Next to type of membership you would like.
____ Individual, Over 18. - $8
____ Family, Persons residing in the same household. - $10
____ Youth, Persons age 18 or Under. - $5
Total Amount Enclosed $ ________________________
For family membership other than above, please list Names & Birth dates
Names ____________________________________________ Birth date ______________________
Names ____________________________________________ Birth date ______________________
Names ____________________________________________ Birth date ______________________
Names ____________________________________________ Birth date
______________________
Print form, complete application, enclose a check payable to St. Charles Canoe Club
| Send this membership form to:
Leslie Waterson 235 Stone Manor Circle Batavia, Ill. 60510 |
|
Send questions & news letter Information to:
St. Charles Canoe Club c/o Tave Lamperez 24 Roosevelt St. St. Charles, Il 60147 |
