Top Stick Joes Membership Form

[John Barron]

Top Stick Joes
Membership Form
2009 Season



Name:_______________________________ Phone ___________________

Address:_____________________________ City:_____________________

Zip:_____________ E-Mail:______________________________________

SSN#_________________________

2009 Membership___________________________________$35.00 each
Additional Family member (allowance for 1 additional member)
___________________________________________________$15.00 each

In consideration for the privilege of participating in these events, I hereby release all tournament officials and sponsoring organizations from all claims of injury and or damages incurred in connection with these events. I understand that I am subject to a polygraph exam and that the tournament promoters reserve the right to refuse entry and services to anyone. I release any photos or videos of me.
Club Affiliation_______________________________________________

Signature:___________________________________ Date:____________
____________________________________________ Date:____________
(Signature of Parent or Guardian if under 18)
Prepaid memberships can be done by credit card by calling Marla Barron at 909-263-7185 or faxed to 909-59276714.
Credit card number_______________________Experation date_________________
Billing zip code_______________ There is a 3% surcharge for use of credit cards. PayPal is also available