Join

2011 Membership Application

Name(s): ____________________________________________

Phone: _____________________________________________

Email: ______________________________________________

Address: ___________________________________________

                ____________________________________________

                       (Please print the above information legibly)

Type of Membership (please select 1):

(      )  Family / Couple $10 (2 membership pins)

(     )  Single  $8 (1 membership pin)

$__________ additional donation for player provisions

                     ( Every dollar helps - THANK YOU!)

$_________  Total enclosed - Membership + donation

I would prefer to receive the newsletter via:

(     )  Postal Mail

(     )  E-mail

I'm interested in volunteering to help

(     )  Yes

(     )  No

Print this page and drop it off at the booth or mail to:  Peoria Chiefs Boosters, 8308 W. Vicki Lynn Dr., Mapleton, IL 61547

You may pick up your membership pin at the Booster Club booth at O'Brien Field during the season.

Thank you for your support!!!