PICAYUNE TOUCHDOWN CLUB

MEMBERSHIP APPLICATION

NAME: _________________________________________________________________

ADDRESS: _______________________________________________________________

_______________________________________________________________

HOME PHONE: _____________________ WORK PHONE: ______________________

CELL PHONE: _______________________

EMAIL ADDRESS: _________________________________________________________

DATE OF APPLICATION: _________________________

APPLICANT SIGNATURE: ___________________________________________________

                  AMOUNT DUE:

SEASON TICKET                   $24.00

MEMBERSHIP FEE              $10.00

TOTAL NOW DUE                 $34.00

PREFERRED PARKING PASS ADD $25.00 (OPTIONAL)          ______

TOTAL DUE WITH OPTIONAL PREFERRED PARKING PASS        ______

*Membership expires on June 30 of the following year.

*Please make checks payable to Picayune Touch Down Club.

*Preferred (Reserved) Parking Passes are available on a first come first serve basis.

PAID BY: CASH

CHECK#     RECEIVED BY:           DATE: