CouTOURe Club Membership Registration Form 24-25

CouTOURe Club Membership Registration

Complete the form below to sign up for 2024-2025 membership. Deadline is October 31, 2024
Name*

First NameLast Name
E-mail*
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Birth Date

MonthDayYear
Membership Level?*

CouTOURe Club Returning Member ($350.00)CouTOURe Club Referral ($350.00)CouTOURe Club (18-25 years of age - $200.00)
Why did I return to CouTOURe Clubblanks .
CouTOURe Club Polo Size*

Extra SmallSmallMediumLargeExtra Large
Dress Size (Cabana Life)*

Extra Small - 0-2Small 4-6Medium 8Large 10-12Extra Large 141X - 14-162X - 18-203X - 22-24Other
Emergency Contact*

First NameLast Name
Phone*
Please enter a valid phone number.
Email*
example@example.com
Upload a photo of yourself.*

Cancelof
Deadline
Returning member dues should be paid no later than October 31, 2024. If you need any assistance registering or have questions about registering, please contact membership.coutoureclub@gmail.com.
Membership Referrals
As we continue to grow our membership through member referrals, please submit all prospective members and/or their contact information to membership.coutoureclub@gmail.com. All prospective members will be contacted directly via email and/or phone to further discuss the CouTOURe Club and our direct impact on the community through our philanthropic support for Children's Charities in Palm Beach County.
Payments can be mailed to:

CouTOURe Club

P.O. Box 3042

Jupiter, FL 33469

*Checks payable to Children's Healthcare Charity, Inc.

Want to pay by Credit Card?

CREDIT CARD LINK then click "other" and insert amount.

To keep cost at a minimum we are asking members to include the

3% processing fee ($10.50).

Please add $10.50 to membership dues for a total of $360.50.

Thank you!
Should be Empty:

CouTOURe Club Membership Registration

Deadline

Membership Referrals