(LAST) (HUSBAND'S NAME)ADDRESS: _____________________________________________________________
HOME PHONE: _________________________ WORK:_______________________
EMAIL ADDRESS:______________________________ BIRTHDAY:____________
SPECIAL INTERESTS:__________________________________________________
SIGNATURE OF APPLICANT:___________________________________________
Enclosed is my check made payable to the Park Ridge Juniors in the amount of $45.00. This includes the $35.00 yearly dues, plus the $10.00 application fee.