SMITHFIELD ATHLETIC BOOSTER CLUB SMITHFIELD HIGH SCHOOL MEMBERSHIP YEAR 2011/2012
DATE: ___________________
MEMBERSHIP FEE IS $5.00 PER PERSON PER YEAR
# OF MEMBERS: _______ TOTAL AMOUNT:_________ Cash Payment: ________ Check Payment: Check # ___________ (Make checks payable to Smithfield Athletic Booster Club) MEMBER’S NAME EMAIL (Please print clearly): ______________________________ ____________________________ ______________________________ ____________________________ ______________________________ ____________________________ HOME ADDRESS _________________________________________________________ CITY _________________________ ST_____ ZIP _______________ HOME PHONE # ________________ CELL PHONE # ________________ LIST OF ALL SMS/SHS STUDENTS IN FAMILY: ________________________________GRADE ________ SPORT(S) __________________ ________________________________GRADE ________ SPORT(S) __________________ ________________________________GRADE ________ SPORT(S) __________________ ________________________________GRADE ________ SPORT(S) __________________ Thank you for your support. If you would like to offer your time and talents to Smithfield Athletic Booster Club, please consider helping with the following committees: (check all that apply) ____Board member ____ Concessions (_____________for which sports event?) ____Fundraising ____ Spirit wear ____Team parent rep ____General volunteer ____Membership ____Funds Distribution ____Banquets ____Senior recognition Please list any other skills, interests or talents: ________________________________________________ My company is interested in being a Corporate Sponsor: Yes No (Please circle one) Mail form to: Smithfield Athletic Booster Club P O Box 95 Smithfield VA 23431-‐0095
FOR OFFICIAL SABC USE ONLY Received by:___________ Date received:________ Received by membership:________