Powell Sertoma Membership Form

Powell Sertoma Membership Form

Online Membership Dues • $42.00 Initiation • $42.00 per quarter year (no lunches included) A lunch is $9.00. • $98.00 per quarter (includes lunch once each week). To apply for membership please complete all questions.
Mr., Mrs., or Ms.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Cellular Number*

Area CodePhone Number
Work Number

Area CodePhone Number
Website
I agree to support the Powell Sertoma Club by my attendance and participation. I further agree to abide by the BY LAWS/Regulations set forth by the membership. I also understand that the Powell Sertoma Club is a non-profit organization originated to make charitable contributions. My participation in sponsored events, including weekly meetings, is voluntary and I agree to hold the Powell Sertoma Club harmless in the event of any accident or injury I sustain through my participation.
Online Membership Form
prevnext( X )
Initiation$42.00

Quarterly (No Lunches)$42.00

Quantity

Quarterly Dues Includes Weekly Lunch$98.00

Quantity

Total $0.00
*
Should be Empty: