Bellevue Senior Community Center

2012-2013 Booster Club Enrollment Form

Name: ____________________________________________
Address: __________________________________________
City: ______________ State: _____ Zip Code: __________
Email address: _____________________________________
Phone number: _____________________________________
o Yes! I would like to join the 2012-2013
Bellevue Senior Community Center Booster
Enclosed please find my $20.00 yearly dues in the form of:
o Cash
o Check
* Note: Couples who wish to join should include $40.00 cash or check.
Return this enrollment form and your dues to:
Bellevue Senior Community Center, 109 W. 22nd Ave., Bellevue, NE 68005

Bellevue Senior Community Center

2012-2013 Booster Club Enrollment Form
Name: ____________________________________________
Address: __________________________________________
City: ______________ State: _____ Zip Code: __________
Email address: _____________________________________
Phone number: _____________________________________
o Yes! I would like to join the 2012-2013
Bellevue Senior Community Center Booster
Enclosed please find my $20.00 yearly dues in the form of:
o Cash
o Check
* Note: Couples who wish to join should include $40.00 cash or check.
Return this enrollment form and your dues to:
Bellevue Senior Community Center, 109 W. 22nd Ave., Bellevue, NE 68005