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]