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Membership Application
Please feel free to print or
copy this form and join the Fan Club today!
Name________________________________________________
Mailing Address_________________________________________
City__________________________State_________Zip_________
Email Address
_________________________________________
Province_____________ Country___________ Postal Code___________
Phone(____)________________Birthday_______________
Referred
By:
Name_____________________________
Please check
one:
o New Member
o
Renewal
Credit Card Orders
We are now required
by the bank to enter your address and zip code for each credit card
purchase.
The credit card holder address must match your address or we will
not be able to process the card.
Credit Card#____________________________Expiration Date____________
o Visa o Mastercard
Signature
_______________________________________
Annual membership
fee:
US $20
Outside US $25/US Funds
Only.
Make check or
money order payable to the Sammy Kershaw Fan Club.
Please mail this form (you may make copies as needed) and your fee
to the address below.
Sammy Kershaw
Fan Club
817 18th Aveune S.
Nashville, TN 37203
Fan Club Fax #(615)320-9557
Please feel free to print or
copy this form and join the Fan Club today!
Name________________________________________________
|
|
Credit Card Orders We are now required by the bank to enter your address and zip code for each credit card purchase. The credit card holder address must match your address or we will not be able to process the card. Credit Card#____________________________Expiration Date____________ o Visa o Mastercard Signature _______________________________________ |
Annual membership
fee:
US $20
Outside US $25/US Funds
Only.
Make check or
money order payable to the Sammy Kershaw Fan Club.
Please mail this form (you may make copies as needed) and your fee
to the address below.
Sammy Kershaw
Fan Club
817 18th Aveune S.
Nashville, TN 37203
Fan Club Fax #(615)320-9557
|
US $20
|
|
Outside US $25/US Funds
Only.
|
Make check or
money order payable to the Sammy Kershaw Fan Club.
Please mail this form (you may make copies as needed) and your fee
to the address below.
Sammy Kershaw
Fan Club
817 18th Aveune S.
Nashville, TN 37203
Fan Club Fax #(615)320-9557