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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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