WELCOME CLUB OF THE FOX VALLEY  MEMBERSHIP FORM

Name:       
Address:   
City:          State: Zip Code:
Telephone  Email address:

Your Birthday Month: Day:
Husband's Name:Hometown (City, State):
Membership Dues and Fees:
    $25.00 for full year (September through August)
    $5 additional if you want your monthly newsletter mailed to you (it will be sent via email for free!)                     
    $ 1.00 additional if you wish to have your Club Directory mailed. (no charge if picked up at meeting)
    $ 6.00 additional if you wish to have a permanent magnetic-backed nametag
                 Print first and last name as you want it on your nametag:               
Total amount enclosed is  We are pleased to have you join us! 

Checks should be made payable to "Welcome Club" and sent to:

Nancy McNamara 1500 S. 14th St., Unit 314,  St. Charles IL 60174

 For information, please phone Nancy McNamara (630) 945-3696 or Sue Lingle (630) 966-2538.

Check if you wish to receive the monthly newsletter by e-mail. Did you give us your e-mail address?
PLEASE READ AND SIGN THE INSURANCE LIABILITY WAIVER. Thank you.

Please read and sign the following waiver.  A membership application with an unsigned insurance waiver cannot be processed

"I agree to assume the full risk of any injuries, damages or loss regardless of severity which I or my family or guests may sustain as a result of participating in any Welcome Club activities. I agree to hold harmless all club members and the Welcome Club board from any and all claims resulting from injuries, damages and losses sustained by me or my family or guests arising out of, connected with, or in any way associated with the activities of any of the programs. I have read and fully understand the waiver and release of all claims."
Member's Signature: Date:
Fill in fields at top of form then submit to your printer. Please sign the form.

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Last updated 05/23/17