2003 Membership Application

2009 Membership Application

New___ Renewal ___

Full Year (January thru December) Membership $22

This membership includes reduced rates for special club activities and a bi-monthly newsletter.

Please print clearly!

Last Name: ________ First Name:

Address: _____________________________________________________________

City: ____________________________ State: __________ Zip: ________________

Telephone: (Home or Cell) ____________________________

Birth Month & Day: / (no year required)

Club Telephone Directory: A directory will be made available to members who wish to have their name and phone number published.

Yes No

Please enclose your email address so we can send you important updates.

After sending us your application, please send an email to: yardleysinglesclub@yahoo.com to confirm the email address you have provided us. Put your first and last name in the email. Thanks.

E-mail address: ______________________________________________________

We do not disclose your phone number or email address to anyone

without your permission.

Are you willing to host a house party in your home? Yes: _ No: _

For club use only

Date App. Rcvd: __________________

Received By: _____________________

Check # _______ Amt: ________

Cash Rcvd: _______ Member # _____

Newsletter given: Yes____ No: _____

Visit the website at www.yardleysingles.org, call the hotline at (215)-736-1288 or email us at yardleysinglesclub@yahoo.com.

Please mail this application with a check for $22.00 to:

Yardley Singles Club, Inc.

Last Name: ________ First Name:

Telephone: (Home or Cell) ____________________________

Birth Month & Day: / (no year required)

Club Telephone Directory: A directory will be made available to members who wish to have their name and phone number published.

Yes No

Please enclose your email address so we can send you important updates.

E-mail address: ______________________________________________________

Are you willing to host a house party in your home? Yes: _ No: _

For club use only

P.O. Box 563

Yardley, PA 19067

Last Name: ____________________________ First Name: ____________________

Telephone: (Home or Cell) ____________________________

Birth Month & Day: ____ / ____ (no year required)

Club Telephone Directory: A directory will be made available to members who wish to have their name and phone number published.

Yes ________ No ________

Please enclose your email address so we can send you important updates.

E-mail address: ______________________________________________________

Are you willing to host a house party in your home? Yes: _____ No: _____

For club use only

P.O. Box 563

Yardley, PA 19067

Last Name: ________ First Name:

Birth Month & Day: / (no year required)

Yes No

Are you willing to host a house party in your home? Yes: _ No: _