2003 Membership Application

YARDLEY SINGLES CLUB

Hotline: 215-736-1288

www.yardleysingles.org

2012 Membership Application

New___ Renewal ___

Full Year (January thru December) Membership - $25.00

Reduced rates for special club activities and a bi-monthly newsletter.

Please print clearly!

Last Name: First Name:

Address: _____________________________________________________________

City: ____________________________ State: __________ Zip: ________________

Telephone: Home: Cell:

E-mail address: ____________________________________

Birthday Month: Date:

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

Please mail this application with a check for $25.00 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 _____
e will not disclose your address, phone number or email address without your permission.

Revised 10-09

Last Name: ________________________ First Name: ________________________

Telephone: Home: ________________________ Cell: ________________________