Membership Form
Please print, complete, and mail to:
The Lime
P.O. Box 6876
Avon Park, FL 33826-6876
Make Checks payable to: Bruline Bikar
Last Name: |
__________________________________________ |
| First Name: | Mr. Mrs. Ms. ______________________________ |
| Mailing Address: | __________________________________________ |
| City, State, Country: | __________________________________________ |
| Phone: | __________________________________________ |
| Email: | __________________________________________ |
| D.O.B or Age | __________________________________________ |
| Occupation: | __________________________________________ |
| ______________ | Would you be interested in After Work Events? |
| ______________ | Would you be interested in Day Trips? |
| ______________ | Would you be interested in Weekend Trips? |
| ______________ | Would your company be in Group Travel? |
| ______________ | Would you be interested in Co-Ed Sports? |
| ______________ | List Favorite Sport/Hobby: |
| ______________ | Would you be interested in Couples Events? |
| ______________ | Would you be interested in Singles Events? |
| ______________ | Would you be interested in Mixed Events? |
| ______________ | Would you be interested in Family Events? |
| ______________ | Would you be interested in driving to Events? |
| ______________ | Would you be interested in transportation to Events? |
______________ |
Referred by: |
______________ ______________ |
PayPal Confirmation Number Check Number __________ |
