Peterson Spouses' Club Membership Card

2008-2009

Name: ___________________________________       Phone (____) _____-_______

Sreet Address: ______________________City:___________________  Zip ________

E-Mail: ______________________________________________________________

I prefer receiving mail by   ___ USPS or   ___ email

Spouse's Name: ________________________  Unit: __________________________

Rotation Date: ________________

Your personal infomration will not be sold; it is for club business only.

May we include your information in our club directory? ___ Yes  ___ No

I understand my rights as a PSC member as stated in the PSC Constitution and the PSC Charitable Assocation Constitiution (Signature required for membership).

Signature: _____________________________________________________

Payment of Dues:  ___ Check       ___Cash       ___ PayPal Bank Transfer

** Dues are $30.00 per year for all members**

Date Paid _____       Check/Transaction # _________

Your birthday (month/day only): ______________________________

Children (and birthdates): ___________________________________________________ ________________________________________________________________________ ________________________________________________________________________

Intersts (i.e., bunko, stamping/scrapbooking, mah jongg, moms & tots, reading, new adventures, quilting, etc.): ___________________________________________________ ________________________________________________________________________

If you have chldren who could provide childcare to other children during our functions or at other times, please provide their name, age, phone number and availability below: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

Business you would like to advertise in the Club Directory or on our Webpage: ___________ ________________________________________________________________________

Return to: PSC Treasurer 260 Glasgow Ave., Bldg. 1013 Colorado Springs, CO  80914-1580