2009 New Members Application

Partial Year (July thru December) Membership $15

This membership includes reduced rates for special club activities and a bi-monthly newsletter.

Please print clearly!

Last Name: ____________________________ First Name: ____________________

Address: _____________________________________________________________

City: ____________________________ State: __________ Zip: ________________

Telephone: (Home or Cell) ____________________________

Birth Month & Day: ____ / ____ (no year required)

Club Telephone Directory: A directory will be made available to members who wish to have their name and phone number published.

Yes ________ No ________

Please enclose your email address so we can send you important updates.

After sending us your application, please send an email to: yardleysinglesclub@yahoo.com to confirm the email address you have provided us. Put your first and last name in the email. Thanks.

E-mail address: ______________________________________________________

We do not disclose your phone number or email address to anyone

without your permission.

.Are you willing to host a house party in your home? Yes: _____ No: _____

Visit the website at www.yardleysingles.org, call the hotline at (215)-736-1288 or email us at yardleysinglesclub@yahoo.com.

Please mail this application with a check for $15.00 to:

Yardley Singles Club, Inc.

P.O. Box 563

Yardley, PA 19067

For club use only

Date App. Rcvd: __________________

Received By: _____________________

Check # _______ Amt: ________

Cash Rcvd: _______ Member # _____

Newsletter given: Yes____ No: _____