|
Please set browser font size to the smallest size and then print out this form
For Club Application Only
RENEWAL
|
NEW
|
|
Mail to:
S.A.F.E.
Inc.
PO Box 343
Commack, NY 11725
|
Please fill-in the
information below and mail, with your check, to SAFE at the address
above. |
|
Date:
________________________
For information
call: (631) 475-8125
Web Site:
www.NYSAFE.Org
|
Type of
Membership
|
|
[X] Club
- $50.00 |
|
| Club /
Organization Name:
_________________________________________________________________________
|
President:
|
Address:
|
City,
State, Zip:
|
E-Mail
Address:
|
Home
Phone Number:
|
Work
Phone Number:
|
|
Secretary:
|
Address:
|
City,
State, Zip:
|
E-Mail
Address:
|
Home
Phone Number:
|
Work
Phone Number:
|
|
Vice
President:
|
Address:
|
City,
State, Zip:
|
E-Mail
Address:
|
Home
Phone Number:
|
Work
Phone Number:
|
|
Delegate:
|
Address:
|
City, State,
Zip:
|
E-Mail Address:
|
Home Phone
Number:
|
Work Phone
Number:
|
|
|
