TREASURE COAST RARE FRUIT CLUB
MEMBERSHIP APPLICATION
(PLEASE PRINT)
Date:__________2012
New Member _______ Renewal _____
NAME ______________________________________
Address ___________________________________
City ______________________State _____ Zip _____
Phone # _______________________
email __________________________________
Additional Family Member Name:____________________
Dues: Annual Membership - $15 (January - December) - Due January 1st
Make checks payable to Treasure Coast Rare Fruit Club
Mail to:
Treasure Coast Rare Fruit Club
c/o Michael Johnston
925 SW Commonwealth Rd.
Port St. Lucie, FL 34953
FOR TREASURER'S USE ONLY:
Renewal ________________New Member____________
Date Paid:__________Cash Amt:__________Check Amt:________Ck#:______