Comus club

2011-12 MEMBERSHIP ENROLLMENT and RENEWAL FORM

 Please print this form, fill out completely and mail with $600 check payable to Comus Club by Oct. 1.

After Oct. 1, dues are $625.

Mail to: 

 

 

Member Name____________________________________________________________

                                  First                                  Last                                      

Spouse Name____________________________________________________________

                                  First                                 Last                                     

 

Mailing Address__________________________________________________________

                                     Street                                                            Apt. # 

 _______________________________________________________________________

            City                                       State/Province                     Zip/Postal Code

 

Telephone __________________________________________

 

E-mail Address_______________________________________