Adult Club Membership Program Application
Copyright 2010 Tepee Archery & Supply
All Information is Required
Date:
Your name:
Age:
DOB:
Address:
State:
Zip Code:
City:
Cell Phone:
Home Phone:
Email:
Special Medical Conditions or Allergies:
Emergency Contact (Name & Tel#):
Six Month Single Membership for $175.00
Six Month Family Membership for $175.00 + $85.00 each additional person
One Year Single Membership for $300.00
One Year Family Membership for $300.00 + $150.00 each additional person
Choose Membership Type:
Family Membership Only:
Please list information on all family members below:
(If you have more than 5 family members, please provide their information in the comments section below.)
Age:
Name:
DOB:
Special Medical Conditions or Allergies:
Cash
Check
Credit Card
*Monthly Installments (CC only option)
Choose Payment Option:
* Monthly Installment payment option is only available with a credit card. Depending on the membership
program enrolled in, a monthly fee will automatically be charged to your credit card on the 15th of every month.
Questions, comments, or feedback:
Upon receipt of this application by Tepee Archery & Supply, I hereby agree to and accept
the terms of my membership and understand my monthly dues. Monthly dues will be
automatically charged to the credit card on the 15th of every month.
