KARS Ceramic Arts & Crafts Club

Membership Application 2005

Those wishing to join or renew KARS Ceramic Club must first get a KARS Park Membership Card. Cards can be purchased at the KARS Park Country Store, or on base at the NASA Exchange store. Once you have your card, then fill out this form. Be sure to include yours KARS Park Membership Card number in place provided on this form.

Then mail this form with a Self Addressed Stamped Envelope, a photocopy of your KARS Membership Card and your check for *$30.00* annual dues (January 1 through December 31), made payable to KARS Ceramic Arts & Crafts Club. Geri, our Membership Chairman, will send your KARS Ceramics Club Membership Card to you via return mail. For more information call Geri Fortner at 783-0403 or email her at kushequa@gbronline.com.

Member Name:
____________________________________________________________________________________

Address:
____________________________________________________________________________________

_____________________________________________________________________________________

Home Phone:__________________________________________________________________________

Work Phone: __________________________________________________________________________

Cell Phone: ___________________________________________________________________________

Email Address: _______________________________________________________________________

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KARS Card Holder (Qualifying Employee)

Name:_____________________________________________________________________________

Employer: __________________________________________________________________________

Work Phone:________________________________________________________________________

Currently Employed? or Retired? ________________________________________________________

KARS Park Membership Card Number: _______________________(Please include a copy of your card)

Mail to: Geri Fortner - 4800 N. Banana River Blvd., Cocoa Beach, FL 32931-3614

*CLUB MEMBERSHIP "TWO FOR ONE SPECIAL"
Through Dec. 31, 2005 - TWO members may join for $30.00 - $15.00 each - instead of $30.00 each. Please mail both membership forms at the same time.

Last Update 11-06-05

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