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THE OLYMPIAN CLUB PROVISIONAL MEMBERSHIP APPLICATION
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PLEASE TYPE all information in form below for legibility ... then PRINT PAGE and SIGN: |
(1) Name:
Sex
Single / Married / Divorced
Birthdate
(2) Name:
Sex
Single / Married / Divorced
Birthdate
Name(s) you want on your Olympian badge(s) (1)
(2)
(max. 12 letters each)
Street Address: Phone # day evening
City: State: Zip:
E-mail:
*Current AANR member?:
AANR Club Name
Member #
Expires:
Date (1) Signature (required) __________________________________________________
Date (2) Signature (required) __________________________________________________
• Once accepted, do you wish to be listed in the Membership Directory
(available only to other listed members)?
YES
NO
• How did you hear about The Olympian Club?
Membership Fee Schedule: Select Olympian Club Membership desired:SingleCouple
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Mail form and appropriate amount to: |
Olympian Club Membership |
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The
Olympian Club |
Select: |
Single | Couple |
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Annual Dues: |
$30.00 | $50.00 | |
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One-time processing fee (includes Club Name Badge(s)): |
$15.00 | $30.00 | |
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Olympian Club Total: |
$45.00 | $80.00 | |
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TOTAL ENCLOSED |
☼$ | ||
ENCLOSE CHECK made payable to: THE OLYMPIAN CLUB • MAIL TO: address as shown.
Thank you, we look forward to meeting you.
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The Olympian Club Is associated with: |