Old Farmers Ball Membership Form

Cost $5, Benefits - support the dance, $1 off admission, newsletters

Check the 'omit' boxes if you don't want that information printed in the OFB directory.

First Name		omit
Last Name
Address 1		omit
Address 2
City
State
Zip Code
Phone xxx-xxx-xxxx		omit
E-mail		omit
Birthday yyyy-mm-dd or mm-dd		omit
Gender	Male Female
Mailings	Snail Mail Newsletter E Mail Newsletter E Mail Other Mailings
Volunteer	Contact me about volunteering
Occupation / Avocation		omit
	Cost of Membership, $5 / year