JUPITER PETANQUE CLUB INC. (Send application and dues to: Jupiter Petanque Club Inc. attn Stephan Soilleux PO Box 3324 Tequesta Fl 33469)
CONTACT INFOS
Lastname: First Name
Address:
City: State: Zip:
Phone (Home): Phone (Cell): Email:
PERSONAL INFOS
Citizenship: Birthdate (M/D/Y): M / F (CIRCLE ONE)
MEMBERSHIP CATEGORY
1. Adult $50.00 new members after June 30th $35.00
2. Family (Couple, same address) $60.00. New Family after June 30th $40.00
3. Familiy Junior FREE
4. Junior (Under 18 years old) $10.00
5. Associate* $25.00. Must be amember of FPUSA or belong to a FIPJ recognized National Federation.
6. Student under 25 years old (with valid ID) $20.00
Late Fees: The FPUSA will assess a $5.00 late fee to any previous FPUSA memebr who signs up after January 31st. So an adult membership will be $55.00, Junior $15.00, etc. New and associate members are not subject to the late fee.
Instructions:Please print, complete and sign one form for each applicant.Enclose a check payable to Jupiter Petanque Club Inc, in the amount indicated according to the membership selected plus any late fees if applicable.Dues are payabe upon submittal of the application.
Citizenship:Please provide a country name, for example USA, France,Vietnam,etc. DO NOT WRITE "US RESIDENT ALIEN".
Submitting a photo:
You can enclose with your application a small passport style photo (no hat or sunglasses), or you can send a digital photo (jpegvia email to jupiterpetanque@gmail.com
By requesting membership to the Jupiter Petanque Club Inc. you agree to abide by the By-laws of the Club and shall be entitled to all benefits and privileges of the Club.
DATE: SIGNATURE:
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