Card# _____________
Name: ______________________________________ Date of Birth:______________
Name: ______________________________________ Date of Birth:______________
Name: ______________________________________ Date of Birth:______________
Name: ______________________________________ Date of Birth:______________
Name: ______________________________________ Date of Birth:______________
Address:_______________________________________________________________
_______________________________________________________________________
Email: __________________________________________ Phone: _________________
Please make checks or money orders payable to the Portland Professional Hockey Booster Club or PPHBC
Adults:_______$10.00 Senior Citizens:_______$7.50 Juniors:_______$7.50
(65 and over) (under 16)
Please check whether you will pick up your membership card or if you would
like it mailed: Pick up at 50/50 table:___________ Mail ____________
Season Ticket Holder: Yes____ No____ 20 game Holder: Yes____ No____
Other:_____________ Seat Location:_______________________________
Membership applications may be returned to the Booster Club table during any home game
or mailed to: Portland Professional Hockey Booster Club
PO. Box 6480
Portland, Me. 04102-6480
WE WILL NEED YOUR HELP! Please check off committees you would like to help with.
50/50 Committee (must be 18 or older) YES___ NO___
Newsletter Committee YES___ NO___
Passing out Promotional Material YES___ NO___
Baking for Parties YES___ NO___
Welcome/Entertainment Committee YES___ NO___
Trip Committee YES___ NO___
Please indicate the best time for us to contact you: AM ____________ PM ____________