Club Blue Form

Membership Level

Professional ($25 per month)
Ambassador ($40 per month)
Champion ($60 per month)
Professional ($300 per year)
Ambassador ($480 per year)
Champion ($720 per year)
Other

Your gift of $25 a month covers the annual membership fee for one youth.

Your gift of $40 a month helps cover the cost of safe transportation for members to the Club.

Your gift of $60 a month helps provide technology and internet connectivity for youth.

Kickball Sign-Up

Club Blue Member Kickball Fee ($35)
Non-Club Blue Member Kickball Fee ($50)

If you sign-up to be a part of the 2019 fall kickball team, please select the appropriate fee and submit your payment here. If you are a Club Blue member, your fee is $35. If you are not a Club Blue member, your fee is $50. Your t-shirt is included in your fee.

Contact Information

Name

First Last

Email

Phone

Address

Street Address Address Line 2 City State ZIP Code

Birthday

Preferred Name for Gift Acknowledgment

Payment Information

Credit Card

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name