POTL Club Membership Application Form

Patriots of the Leaf Membership Application

Complete the form below to sign up for POTL membership.
Name*

Last NameFirst Name
Membership Type*
Occupation*
E-mail*
example@example.com
Shirt
Shirt Size
Street Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Territory*
South
Central
North
Phone Number:*

Area CodePhone Number
Cell Phone Carrier- This will be used to send Meeting Reminders and Important Info*

VerizonT-MobileATT&TBoostCricketOther
Facebook Name (If applicable) This is so you can be added to our private Facebook Page
Agency Name (if associate: type associate)*
Title/ Rank (if associate: type associate)*
Associate Member Job Title
If Associate Member, Sponsored by?
Name of Active Member
Birth Date:*

MonthDayYear
Patriots of the Leaf (P.O.T.L.) is a private members only organization. By siging up to be come a member you agree not to share the organization's business among non-members, unless otherwise given permission. Failure to do so can result in termination of membership Furthermore you agree to follow all bylaws and by signing you acknowledge all bylaws set forth for Patriots of the Leaf
Bylaws Acknowledgement*

I have read, understood, and accepted the PRIVACY POLICY and BY LAWS for membership.
Once you submit your application, we will contact you shortly to complete your membership application. Thank you!
Signature*

Clear

My Products*

Active Membership 2025 -$90.00Membership Fee and the One-time Initial Application Fee of $40 All new member club items will be mailed to residence . Each calendar year After Active Membership will be $40.00

$90.00

Associate Membership 2025 - $110.00 Membership Fee and the One-time Initial Application Fee of $40. All new member club items will be mailed to residence.Each Year After Active Membership will be $40.00

$110.00

Subtotal

$0.00

Shipping

$0.00

Total

$0.00

Payment Methods

Credit Card

Apple Pay

Google Pay

Should be Empty:

Patriots of the Leaf Membership Application

Payment Methods