PITTSBURGH PENGUINS BOOSTER CLUB APPLICATION FOR MEMBERSHIP Name : _____________________________________________________ Address : _____________________________________________________ _____________________________________________________ _____________________________________________________ Telephone Number : ( ) ___________________________________ Date of birth : ______________________________________________ Membership : Member _______ Out of Town ________ Signature of Applicant : ______________________________________ Date of Application : _________________________________________ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ( For Booster Club Use ) Signature of Booster Member : ________________________________ Date Accepted for Membership : ________________________________ Web Page Registration
Please print this form and mail it along with your payment drawn on US funds to the following address :
Pittsburgh Penguins Booster Club
Attn: Membership Committee
P. O. Box 903
Pittsburgh, PA 15230
Refer to the Membership page for membership costs.