FLORIDA SOUTHERN COLLEGE MEN'S LACROSSE FACE-OFF CLUB
®
FACE-OFF CLUB MEMBERSHIP APPLICATION LEVEL I – ASSIST – $100 ....................................................................... $________ LEVEL II – GOAL – $150 ........................................................................ $________ LEVEL III – HAT TRICK – $250................................................................ $________ LEVEL IV – ALL-AMERICAN – $500....................................................... $________ LEVEL V – CHAMPIONSHIP – $1000..................................................... $________ LEVEL VI – CORPORATE – $2500.......................................................... $________ Reserved Seating ($75)............................................................................ $________ VIP Parking ($75)...................................................................................... $________ One Additional Adult Ticket for Levels II-VI ($50)...................................... $________ T O T A L P A C K A G E........................................................................ $________ Check enclosed payable to Florida Southern College Men's Lacrosse Charge my:
American Express
Discover
MasterCard
VISA
Card Number________________________________________________________ Exp. Date Name as it appears on the card__________________________________________________ Signature___________________________________________________________________ (PLEASE PRINT)
Name ______________________________________________________________________________________________________ Home Address________________________________________________________________________________________________ City________________________________________________________________ State__________________ Zip____________ Business Address City________________________________________________________________ State__________________ Zip____________ Cell Telephone (
)________________________________
Business Phone (
)____________________________________
Email Address______________________________________________________________________________________________ To subscribe to "SnakeBytes", the Mocs' weekly e-newsletter, go to fscmocs.com Make Check Payable to Florida Southern College Men's Lacrosse and mail to:
Finley Allen • Florida Southern College 111 Lake Hollingsworth Drive • Lakeland, FL 33801-5698
For additional applications, or questions, call (863) 680-4109