SVS Membership Enrollment Form

Please write legibly!

Membership type? (Check one): Individual - $35 ____Family - $50 ____Student - $20 ____

Enrollment date ____________ (Important)

Note: Full dues are assessed for new members enrolling through August 31 of each year. Members enrolling September 1 and after will be assessed half the normal rate. Dues are on a calendar year basis and should be paid on or before January 1 of each year.

*For family memberships, please indicate each member’s first and last name and birthday.

Name_____________________________________ Birthday ________________

Additional Members:

_________________________________________________________________________________________

Street Address__________________________________________________________________ City__________________________ State _______ Zip _____________

E-mail address ______________________________

Home Phone _______________________ Work Phone _____________________

Employer Name _____________________________________________________

Type of equipment owned_____________________________________________________________________________________

What ideas do you have for the club__________________________________________________________________________

What topics would you like discussed in the newsletter or at our meetings______________________________________________________________________

What types of activities or programs are you interested in____________________________________________________________________________

Please DO NOT fill in the following!

Check when completed: Name tag(s)_____ Gate Card_____ Rules_____ Paid_____ Email_____ A/L_____