membershipapp

MEMBERSHIP APPLICATION FOR THE
MID-ATLANTIC CLOWN ASSOCIATION

Please include type of membership below. Fill out separate form for each person joining M.A.C.A. (including family members). * see below.

I understand that by signing this application, I do hereby promise to conduct myself im an upgrading manner at all times while I am in clown costume. I do further promise never to use vulger 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.

If you were invited to join by someone, please put their name on the line below. (This is not requierd; 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 Jayne Urquhart, 9485 Hinkston Rd., Guys Mills, PA 16327.

* All memberships expire September 30th of each year. New members are asked to pay for one year ($20.00) plus $1.70 ($0.83 for family members) per month for each month remaining until September. If pro-ration fee is not included with your application, your membership will expire at the end of September of the current year and your renewal will be $20.00 effective October 1st.

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Click here for Alley application.

New Individual Membership @ $20.00/year:

Renewals - Individual Membership @ $20.00/year:

Family Memberships @ $10.00/year each additional person:

NAME:

MEMBER # :

(if re-newing)

ADDRESS:

CITY:

STATE:

ZIP:

PHONE #: (home):

PHONE #: (work):

BIRTH DATE:

CLOWN NAME:

E-MAIL ADDRESS:

Clown organizations to which you belong:

Signed:

Date:

(Type your info. in the spaces provided then print form and mail.)

COUNTY: