|
Way Out Club
Membership Application
|
Name:____________________________________
Address:___________________________________
State & Zip:_________________________________
Phone Number: ( )__________________________
Sobriety Date if any: _________________________
Email Address:______________________________
Please Print & Mail to:
Way Out Club
226 Cherry Street
Greenfield, Indiana 46140
Please enclose your check or money order for the appropriate amount of dues
|
|
