Returning Member Application

Returning Member Application
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Member Number*
Birth Date
Reason for leaving*
Are you on Face Book? (Please put your profile URL below so that we may add you to our private group) *
Please attach a picture of yourself*

Cancelof
Please submit your payment of $275.00 with this form for review, once
we receive the application and payment the Krewe of Agustina's Board
of Directors will review your application. If you are not approved we will
return your payment.

Square: https://krewe-of-agustina.square.site/renewal-dues

Krewe of Agustina de Aragon
4532 W Kennedy Blvd
PMB 329
Tampa, FL 33609
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