Maryland Freestate Treasure Club

MARYLAND FREESTATE TREASURE CLUB

MEMBERSHIP APPLICATION

To join, print out this page, complete the information and enclose a check for $25.00 made payable to: Maryland Freestate Treasure Club. Mail to: Charles Blenkner, 9943 Harford Road, Baltimore, MD 21234, or bring the application to the monthly meeting. The membership fee extends membership to the applicant's spouse and children under the age of 16.

NAME:

ADDRESS:

CITY: STATE: ZIP:
TELEPHONE#: EMAIL ADDRESS:

SPOUSE'S NAME:

CHILDREN'S NAMES (UNDER 16):

________________________________________ AGE: ______________

________________________________________ AGE: ______________

PARK PERMIT NUMBERS: YOU:____________________ SPOUSE:____________________

OCCUPATION:

HOBBIES:

PROGRAMS YOU WOULD LIKE TO SEE THE CLUB PRESENT:

I WOULD BE GLAD TO ASSIST THE CLUB BY:

CLUB USE ONLY:

PAID: CHECK: DATE:

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NAME:
ADDRESS:
CITY:	STATE:	ZIP:
TELEPHONE#:	EMAIL ADDRESS:
SPOUSE'S NAME:
CHILDREN'S NAMES (UNDER 16): ________________________________________ AGE: ______________ ________________________________________ AGE: ______________
PARK PERMIT NUMBERS: YOU:____________________ SPOUSE:____________________
OCCUPATION:
HOBBIES:
PROGRAMS YOU WOULD LIKE TO SEE THE CLUB PRESENT:
I WOULD BE GLAD TO ASSIST THE CLUB BY:
CLUB USE ONLY:
PAID:	CHECK:	DATE: