Hazelmere Men's Club
2010 Membership Registration Form

Name:                           E-mail:    Telephone #: 

Street Address:   City:   Postal/Code:

Comments:

If you are taking advantage of the 2 memberships for $100 please advise us of the new member
Name         Membership #:     Email:   

* new member cannot have been a member of the Men's Club in the years 2007 and 2008
By submitting this registration form you are authorizing the Hazelmere Men's Club to have your 2008 dues charged to your members account.

Yes,  please sign me up for the Hazelmere Men's Club registration
                  and charge my account #  

                  2010 Dues are $75.00

Thank you,
Hazelmere Men's Club Executive