Membership form2021

CSRA SHAG CLUB MEMBERSHIP APPLICATION

NEW MEMBERS MUST BE 21 YEARS OF AGE.

PLEASE COMPLETE ALL INFORMATION EVEN IF RENEWING SO THAT RECORDS WILL BE COMPLETE AND CORRECT.

APPLICATION DATE (Month/Day/Year)

PLEASE CHOOSE ONE:

NEW RENEWAL

FIRST NAME

LAST NAME

ADDRESS

CITY

STATE

ZIP CODE

HOME PHONE

WORK PHONE

CELL PHONE

Email-Preferred Email for Club Correspondence

BIRTHDAY (MONTH/DAY)

We are asking each member to consider participating in the clean-up of at least one club part during the year and serve on at least one committee. Please select one major commitee below on which you are willing to serve:

Do you authorize your address and telephone number to be released to the membership:

YES NO

This form may be printed. Membership dues must be included with this application. Make checks payable to : CSRA Shag Club, Inc. and mail to :

CSRA Shag Club
c/o Sonji Aycock
3766 Boulder Trail
Augusta, GA 30907

MEMBERSHIP DUES

New Member $52.50 Renewal with Classic Coupon $47.50 Renewal without Classic Coupon $52.50