Membership Dues Per Year (October 1, 2003 through September 30, 2004)
Renewals: Adults .00, Under 18 .00, Family .00**
* New Members: Adults .00, Under 18 .00, Family .00**
(.00** for two adults)
* Includes New Member Fee.
** All members of the family must reside at the same address.
Please list each member’s name, birthday, and note if under 18 years old.
Total Enclosed
Check here if under 18 years old ________
Name ____________________________________________________________________________________
Address __________________________________________________________________________________
City, State & Zip Code ______________________________________________________________________
Telephone ______________________________
Birthdate (month/day) ______________________
Make check or money order payable to: Milwaukee Admirals Blueliners Club or MABC
Send to: Leave blank for Membership Committee use
MABC
Membership Committee
P O Box 170742
Whitefish Bay WI 53217-8061
Application No. __________
Date ____________
