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12/15/2017

 

                                                  BOYS & GIRLS CLUBS OF NORTH CENTRAL ALABAMA

 

                     (Formerly Red Shield Club - Boys Club of Decatur - Boys & Girls Clubs of Morgan - Morgan & Lawrence) 

 

                                                                                         Alumni Association Application 
 
 

 Please circle one or more of the following:  Past Member       Staff       Coach     Sports Player     Volunteer       Board Member       Committee Member                               

                                                            
                                                                        Note:  Alumni must be 19 or older.
 
 What Organization or Club were you affiliated with?  _____________________________________________________________

 City ____________________________________      State ___________________________  

 
 Approximate date(s) of your involvement?   _______________________________________                    
_______________________________________________________________________________________________________________________________ 
 Applicant's Name: _______________________________________________________________________________

                                                        First                                  Middle                               Last

 Male____ Female____

 Address: __________________________________________ City: _____________________________

 State: _______ Zip Code: _________

 Birth date: ___/____/_______ Race: Black ____ White ____ Hispanic ___ American Indian ___ Mixed ___ Asian ___ other _____

 
 Occupation: _________________________________________________________ 

 Retired:   Yes ___ No __                                            

_______________________________________________________________________________________________________________________________
 Alumni Contact Information: Home # _____-______-_____ Cell # ____-_____-_____ Work # ___-_____-___  Email Address: ________________________

 Mailing Address:  _________________________________________________________________

 City _______________________________________________ State ________________________  

 Zip Code __________________                                                 
                                                                                                          Alumni Annual fees $20
(This section to be completed by B&GC staff)  Application Received: ___/___ 20____   
 
Mail Applications & Make Checks Out To:    Boys & Girls Clubs of North Central Alabama
                                                                 P. O. Box 1431   Decatur, Al 35602-1431
 

Amount received _________ Check ___   Cash ___     Check # ________________

For questions or additional information call:   David Varner ----256-340-3466 office - cell # 256-508-1023

                                Casey Coleman 256-340-3470 - office
 
Please print and mail completed form.   Thank You

 

 

 

 

 

 

 

 

 

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