MID-ATLANTIC CLOWN ASSOCIATION

INDIVIDUAL/FAMILY MEMBERSHIP FORM

Type Of Membership                                                       
New Membership                
Renew Membership                                                     
Reinstate Membership         
Family Membership            

Membership Number (renewal only)   

                   
                    First Name                Last Name 

                    Address 

                    City          State            Zip code   

                    Clown Name           Email Address   

I understand that by signing this application, I do hereby promise to conduct myself in an upgrading manner at all times while I am in clown costume. I do further promise never to use vulgar language or actions, smoke or drink alcoholic beverages while in costume. I do also promise to be loving and understanding and will lend a smile wherever needed. Lastly, I promise to further the old and fine art of clowning wherever I can and enjoy myself while doing it. 

   Signed                              Date    

If you were invited to join by someone, please put their name in the box below. (This is not required; only if you wish).

Print this form, sign & mail, along with your check or money order (made payable to M.A.C.A.) to Mid-Atlantic Clown Association, c/o Dave Myers, 318 S. Cleveland Ave, Wilmington, DE 19805