|
THE OLYMPIAN CLUB PROVISIONAL |
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)
Phone # day evening
Street Address: 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 below: (Single or Couple)
|
|||||||||||||||||||||||
ENCLOSE CHECK made payable to: THE OLYMPIAN CLUB • MAIL TO: address as shown above.
Thank you, we look forward to meeting you.
|
The Olympian Club Is associated with: |