The 449 Club

Washington's Premier Alcohol-Free Dance and Social Club

The 449 Club Membership Application

 

 

First:_________________________  MI______         Last:__________________________            

_Address: _________________________________

City:__________________________              State:____             Zip:Address:_________________________________

Phone:______________________________   Email:_________________________________ Member#___________________

Birthday Date: Month__________ and Day___________ year optional___________

Signature:_______________________________________                   Date:________________

  Membership Status  (check one)

O       I am a first time member

O       I am renewing my membership

Membership Type    (check one)

O       Annual-   $150.00

O       Monthly- $12.50 (Available with automatic recurring billing)

0       Decade-  $950.00

0      Lifetime-  $ 1500.00

0      I have made a donation in addition to my membership dues.

        ( amount enclosed $_____________________) 

Method of Payment:           Cash______                Check________     Money Order________

The449Club is a Washington State non-profit organization- and a  Federal 501(c)(3) EIN#(27-2106465) non-profit of the Internal Revenue Service (IRS) 

Upon Completion, please drop dues payment off at any OPUS Bank or mail to:

The 449 Club-303 91st Avenue N.E. E-502 PMB #194 Lake Stevens, WA  98258

Visit us on the Web at http://www.the449club.org or email us at [email protected]

 

 

 

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