Membership Application

Spokane Chiefs Booster Club

Name _____________________

Spouse ____________________

Address ______________________________

City, State, Zip _______________________________

Phone – Home ( ) Work( ) ___________________

E-mail address ___________________________

Seat Location Section Row Seat(s) (if season ticket holder)

_________________________________

Type of Membership (please mark one)

__  Family (includes children 17 and under $30.00

living in the same household)

__ Senior (husband and wife with at least one 60 or over) $20.00

__ Junior 17 and under (member sponsor required) $20.00

__ Single 18 and over $20.00

__ Renewal __ New Member Referred by _____________

Members under 18 – Names & Birthdays

__________________________________________

___________________________________________

Mail membership form and dues to:

Spokane Chiefs Booster Club

PO Box 3211

Spokane, WA 99220-3211