Silver Strikers Club Application Page Printable

SILVER STRIKERS CLUB APPLICATION

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MEMBERSHIP APPLICATION
SILVER STRIKERS

Name ______________________________
Address ____________________________
City _______________________________
State _________________ Zip _____-____
Phone ______________________________
E-Mail ______________________________

My areas of interest are:
{ } All { } Atlantic City
{ } Nevada { } Riverboats
{ } Colorado Other _____________________

Denominations I collect are:
{ } All { } $2 { } $3
{ } $7 { } $10 { } $12
{ } $20 { } $28
{ } $40 { } $200 Other _____________________

Check Here if this is a your annual renewal? { } Yes { } No
May we publish the above information in the club roster? { } Yes { } No
SPONSOR NAME:___________________________________ (If none write Club Webmaster)
Do you want the club newsletter e-mailed to you?(no extra cost) YES___ NO____
If yes, e-mail address to send it to. _____________________________________

Mail completed application with your first year dues of $15.00
and a one time new member processing fee of $8.00
Associate membership for spouses is available for an additional $15.00

Make check payable to:

Silver Strikers
c/o Leroy Rico
98-1617 Hoomaike Street
Pearl City, HI 96782-2332
e-mail: membership@silverstrikers.com