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NAME: ______________________________________________ ADDRESS: __________________________________________ PHONE: (Home) (___)_________________________________ Email: _____________________________ _____ $100.00 Single _____ $150.00 Family Couple (i.e., husband/wife, parent/child) _____ $_____ Donation |
MEMBERSHIP APPLICATION |
Membership dues are paid annually by August 30. |
Print, Complete and Mail to address shown. |
(Work) (___)_________________________________ |
MEMBERSHIP LEVELS (Select One) |
____________ Date |
__________________________________ Signature |
Make Checks Payable to: Prairie View Athletic Club P.O. Box 847 Prairie View, TX 77446-0847 Questions? 936.857.5817 |
Dues and Donations are tax deductible. |
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