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CHARTER i MEMBERSHIP ee #006 RENEWAL FORM ‘Term Date: 1/8/2010-177/2011 ‘Our State North Carolina (G36) 286-0600 Name _Bernie Mann Business Phone P.O. Box 4552 Fax No (336) 286-0100 Address Email Address ‘Greensboro, NC 27404 Home Phone No. Social Security or ‘Tex LD. No. 1 Yes, 1 want to renew my Charter Meinbership, I've enclosed a 10% deposit per Coliseum Club seat as required. _2_ NUMBER OF CLUB SEATS @ $2,500.00 per seat — Total Trade $5,000.00 10% Deposit for Each — Amount Due $. CLUB SEAT SELECTION - SECTION 210 ROW A__SEATS 15-16 CARLYLE CLUB MEMBERSHIP RENEWAL “The earlier a renewal is received, the higher its priority in the assignment of available preferred seating and VIP Parking. Payment may be made by check or creditcard payable to: Greensboro Coliseum. Fax or mail this completed Renewal Form, along with deposit to Greensboro Coliseum Complex, PO Box 5447, Greensboro, NC 27435 or Fax this form to (336) 373-2170. Payment Method: [C] Cheek [TJ visa [[] Mastercard [7] American Express [7] Discover {7 ill me Tiling Sohealeramount Print name as 1 appears on credit card ‘Signature ‘Credit Card Number Expiration Date 1 have reviewed the General Terms and Conditions applicable 1o Carlyle Club Membership and Coliseum Club Seating as specified on the reverse of this Form. Tagree tobe bound by such terms andl conditions generally applicable to Carlyle Club Members and Coliseum Chub Seating, 1 understand that the Terms and Conditions on the reverse side of this Renewal Form obligate me to pay anual license fees in advance for one year with a reservation deposit of 10% per membership as required, The deposit, as require, is accompanied with this Renewal Form. | also understand thet my Jeand non-compliance of the Terms and Coniltions on the reverse of “Tasteless the mares ‘Bourbon Correo Buse! Facl usar C Ayah DepntyFinnoe OMe 5 Wo zie Approved by: Approved by: 7 efi2/o aF Sel tfeaje ‘Greensboro Coliseum Director Date ‘ity Attorney } ity Clerk

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