Renewal Membership Application 2024

First Name

Additional Family Member(s)

Birthday (day&month)

Last Name

Address

City/State/Zip

Phone

Email address*

Name as you would like it on your badge

I am internet enabled

Email newsletter, etcMail newsletter, etc

I am interested in helping on a committe

YesNo

If you're interested in helping the committee, please let us know how you can contribute below.

Special EventsMembershipNewsletterPlanningRaffles

Do you have any other resources that would be of help to the club?

Dues

Individual: $25.00 ($30.00 if you need newsletter, etc. mailed)

Additional Family Member(s): $ 5.00 (for each member at same mailing address)

(This contribution is not deductible as a charitable contribution for the Federal income tax purposes.)

Member = _x $5.00 $ _ 25.00
Family = x $5.00 $ _
TOTAL __

Make your check payable to Desert Sharks PHC and send to:

Donald Miller

Membership Chair

8316 N Solitude Way

Tucson, AZ 85743