EmailMe Form - New Member or Renewal Application

Name *
First Last
Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Primary Phone *
### - ### - ####
Alternate Phone
### - ### - ####
We will list your Primary Phone number first in the yearbook. If you enter an Alternate Phone number, it will be listed below the other one.
Automated Phone Calls
Automated phone calls from the Club are OK with me.
I DO NOT want to receive automated phone calls.
Announcements about the Club's upcoming events are occasionally sent by automated phone calls. Please check the 'DO NOT want' box to be removed from our phone calling list.
Email Announcements
Email announcements from the Club are OK with me.
I DO NOT want to receive Email Announcements.
Announcements about the Club's upcoming events are frequently sent by email. Please check the 'DO NOT want' box to be removed from our email message system.
Birth Month
Birth Day
Email
Newsletter Preference
New Member or Renewal *
New Member
Renewal
I will pay my dues by: *
PayPal (Credit Card)
Mailing a check to the MGC office.