RAVENS ROOST #41
MEMBERSHIP APPLICATION
NAME:________________________________ DATE:____________________
ADDRESS:_______________________________________________________
CITY:__________________________________ STATE:____ ZIP:__________
HOME PHONE:______________________ WORK PHONE:__________________
EMAIL ADDRESS:_________________________________________________
OCCUPATION:___________________________________________________
BIRTHDATE: ______________ (Members must be at least 21 years of age.)
OPTIONAL QUESTIONS:
How did you find out about our Roost?_________________________________
Are you a season ticket holder? Yes____ No____
(Note: Dues are $20.00 per year and will be collected every July 1.)
DO NOT WRITE BELOW THIS LINE
DATE SUBMITTED:____________________
NOMINATED BY MEMBER:_______________________________
MEMBERSHIP APPROVED:_______ DISAPPROVED:_______
DUES: DATE PAID:______________
CASH AMOUNT RECEIVED:_______________ BY:________________________
CHECK AMOUNT RECEIVED:______________ BY:________________________
CHECK NO._______________
INSTRUCTIONS:
Print and complete this form, then
mail with check for $20 payable to:
Ravens Roost #41 c/o Alan Epstein 695
Colony Drive Apt. E York, Pa. 17404