Member Information/application

Don't Forget to Pay DUES!!! only $15 and they don't need to paid again until Next May! You will not be allowed to participate in Key Club SOCIAL EVENTS if you have any DUES or FEES Unpaid.... :)

Name *

First

Last

Birthday *

Email *

Home Phone Number *

Cell Phone Number *

I can receive TEXT messages on my cell phone. (If you don't have cell phone please mark false!) *

True False

Address *

Line 1

Line 2

City

State

Zip Code

Country

Grade level In School for 2011-2012 school year -- and approx current cumalitive GPA *

Do you participate in any other Clubs or Activites in SCHOOL? If so, please list name of activity, sponsor/coach, days & meeting time if scheduled. *

Do you participate in any activity outside of school? If so, what, and when do you meet. *

Parent/Guardian Name *

First

Last

Parent Phone Number *