Please complete this page and then

click the submit button at bottom of this form.

Thank you for your support and donation !

This club is for individuals only ...  (No Organizations)

(* information will be kept private and confidential) 

  NAME FOR EACH MEMBERSHIP (First & Last Name)

               (First & Last Name)  
                 (First & Last Name)  
  *ADDRESS     

  *CITY          

  *STATE        

  *ZIP CODE       

  *EMAIL           (If you have no email address type "NONE")

  *YOUR PREFERRED SHAG CLUB OR CLUBS  

MEMBERSHIP TYPE

QUANTITY

Amount

Subtotal

Regular Membership

Other Donation Amount    

TOTAL REMITTANCE

 (PLEASE SEND CHECK)

To: Shagtour

PO Box 399

Salisbury, NC 28145