Powell Sertoma New Membership Form

Powell Sertoma New Membership Form

Online Membership Dues • $45.00 Initiation • $45.00 per quarter year (no lunches included) A lunch is $9.00. • 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
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Quarterly Online New Membership Dues ($84.00 for the first payment then,$98.00 for each three months)
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