NEW MEMBER SIGN-UP  - FALL 2008 THROUGH 2009 CLUB YEAR

Pittsburgh Club Member _______________________ recommends for membership:

Name: (1)______________________________________________________

Name: (2)______________________________________________________

Address  ______________________________________________Zip Code________

Phone  __________________________________________________

Will member reside in The Villages     
Year round ___     -OR-       Seasonally  ___

E-Mail Address:  ___________________________________________________

----------------------INFORMATION TO APPEAR ON BADGE----------------------------

Name: (1)______________________________ Pgh. Location (1) _______________

Name: (2)______________________________ Pgh. Location (2) _______________

Membership including Badge with magnet closure and gold trim:  $10.00 each

If for health or any reason, you desire a PIN rather than a MAGNET closuer,
please initial here:  ___________

INFO APPROVED BY MEMBER  ______________

Amount received by Treasurer____________