Membership Entry Form

From for New members to apply

Member Information

Name(Required)

Prefix First Middle Last Suffix

Year of Birth(Required)

Membership Information

Sponsor 1(Required)

First Last

Sponsor 2(Required)

First Last

Nickname

Occupation

Member Correspondence Address

Address(Required)

Street Address Address Line 2 City State ZIP Code

Member Contact Information

Work Phone

Home Phone

Mobile Phone(Required)

Email(Required)

IMPORTANT:
Membership into the Club is not formally accepted until payment of the current year's dues have been received by the Club Secretary. Please be advised that payment of the current year's dues is due UPON JOINING.

Also be advised that failure to submit your dues ON or BEFORE your installment date will result in revocation of your application.

Please address any questions or concerns to the Club Secretary at: secretary@narragansettlionsclub.org. Thank you.

Electronic Signature

Full Name(Required)

Date Completed(Required)

CAPTCHA

Number