Natick Pegasus

Membership Form

Student - $20.00 Regular - $35.00 Group/Family - $100.00

MEMBER NAME_____________________________________________

ORGANIZATION/BUSINESS___________________________________

ADDRESS____________________________________________________

CITY___________________________STATE_______ZIP_____________

HOME #__________________Best time to be reached: DAY or EVENING

WORK#__________________EMAIL_____________________________

Under 18? YES/NO / Can You Volunteer? YES/NO / Cable Subscriber? YES/NO

Can we share your contact information with other members for productions? YES/NO

In case of emergency contact_______________________________________________

Relationship__________________________Telephone__________________________

Please send form and payment to: Natick Pegasus 2 Summer St. Natick, MA 01760

SIGNATURE______________________________________DATE_____________

(If member is a minor, signature of a parent or legal guardian is required here)

FOR OFFICE USE

CHECK/CASH $_________CHECK#___________DATE RECEIVED__________

MEMBERSHIP START DATE:_____________MEMBER NUMBER____________

MEMBERSHIP TYPE: INDIVIDUAL NON PROFIT BUSINESS

MEMBERSHIP STATUS: NEW RENEWAL