PRINT THIS PAGE St. Basil Adult Singles - Membership / Renewal Form ELIGIBILITY: The group is open to Christian single adults (never married, divorced or widowed) 21 and older. - PLEASE PRINT - NAME: ________________________________________________________________ ADDRESS: ____________________________________________________________ CITY: ___________________________ STATE: __________ ZIP: _________________ PHONE NO.: (_____) ________________ BIRTH DATE: ______/______/_______ E-MAIL:_______________________________________________________________ NEW MEMBER RENEWAL FORMER How did you find out about the group? ________________________________________ Would you like to receive the monthly newsletter by e-mail? YES NO Dues Schedule: From January thru December: $25 for members that receive the newsletter by regular US mail and $20 for members who receive the newsletter by e-mail. (MS Word 97+ format) All memberships will then expire December 31st regardless of date joined. Please mail completed form and payment to:
Make check or money order payable to: St. Basil Adult Singles (NO CASH ACCEPTED) The undersigned understands that their membership
may be terminated if the Board members collectively feel that a member has
abused their membership as a result of non-payment of dues, falsification
of application information or other inappropriate behavior. Signature:
_______________________________________
Date: ______________________ |