Club SPARtans

2019/ 2020 Membership Application & Renewal

Name ________________________________________________

Spouse’s Name ________________________________________________

Note: Fill out this section, only if there have been changes since your last year’s application.

Address ________________________________________________

________________________________________________

_________________________________________________

E-mail Address _________________________________________________

Home Phone Number ___________________________________________

Cell Phone Number ___________________________________________

Years at RCA / Spar / EMS/ MDA: from 19_____ to ______(just for the record)

Amount enclosed ($20)

Date of Application ___________________________________________

Signature ____________________________________________

The two year membership fee is $20.00

If paying by cheque, please make out the cheque to SPARtans.

Cheques made out to “Spartans Club “are to be sent to:

Nicole Bourdeau
Spartans Club
4088 Kuchiran
Pierrefonds QC, H9H4A9.