APPDA CLUB MEMBERSHIP APPLICATION

CLUB MEMBERSHIP APPLICATION
Application Type*

New Club MembershipRenewal Club Membership
Club Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Contact Person*

First NameLast Name
Phone Number*

Area CodePhone Number
E-mail*
Fees. Total includes 3% CC fee. If paying "Friends and Family" you can just pay the dues.*
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Club Membership$150.00

Type

Subtotal $0.00Tax $0.00Total $0.00
Once you hit submit,

If you are paying with a Credit Card or Paypal please go to http://PayPal.com and send FRIENDS AND FAMILY to Memberships@theAPPDA.com

If payment is not received then form is Null and Void.

The APPDA Website
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Date

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