Member Information Form
Collects member details and preferences.
Date
*
/
/
Name
*
Address
*
Email
*
Name of Club
*
Phone Number
*
Fax
Birth Year
*
Race
*
A
White
B
Black or African American
C
Asian/Pacific Islander
D
American Indian
E
Hawaiian
F
Other
Ethnicity
*
A
Hispanic
B
Non-Hispanic
Gender
*
A
Female
B
Male
Date Joined
*
Signature
*
Draw
Type
Upload
Choose your signature image
Date
*
/
/
Witness
Date
/
/
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