MEMBERSHIP APPLICATION FOR THE MID-ATLANTIC CLOWN ASSOCIATION
 

Renewals - Individual Membership @ $20.00/year: __________

Family Memberships @ $10.00/year each additional person: _______

Life Memberships @ $200.00 per person: ____________

ADDRESS: ______________________CITY_______________STATE_____ZIP + 4______________

TELEPHONE # (Home): ______________________(Work)_______________________________

BIRTH DATE: ______________________CLOWN NAME_________________________________________

E-mail address (optional): ___________________________________________________________________

Clown Organizations to which you belong:

1.__________________________________________________________________________

2. __________________________________________________________________________

3. __________________________________________________________________________

4. __________________________________________________________________________

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 on the line below. (This is not required).
_______________________________________________________________________________________
Mail your check or money order (made payable to M.A.C.A.) to Mid-Atlantic Clown Association, c/o Linda Vaughan, 251 Bayberry Ct., Browns Mills, NJ 08031.

ã  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.