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Tulley's II in Monona at 6:30 PM on the second Monday of every month. Details »

Madison Optimist Club Membership Application

Thank you for your interest in joining us as Madison Optimist Club member. We look forward to your participation in helping us serve the youth in our community as Optimists. the informaion below is used internally so we can process your application. No payment is required at this time.

New Member Information

First Name
Last Name
Were you ever a Junior Optimist Member? Yes
No
Are you currently a full-time college student? Yes
No

Home Address

Street
City
State/Province
ZIP/Postal Code
Home Phone
Cell Phone
Email

Business Address

Company Name
Type of Business
Street
City
State/Province
ZIP/Postal Code
Work Phone
Email
Business Position or Title
May we contact you at work? Yes
No

Acceptance of this Invitation

*Signature
Date
Sponsor
Optimist Club of

Individuals who have committed sexual offenses against children may be denied membership and/or have their membership revoked.

Optimist International Member Interest Finder

Greater satisfaction and benefit come from participation in Club activities through committee membership. Please let us know which of these activities you are interested in. Community Service: Plan and supervise projects.
Fellowship: Promote fellowship beyond Club.
Finance: Plan and supervise the budget.
Membership
New Club Building
Programs: Create programs for Club meetings.
Youth Activities: Implement youth projects.

About You

Occupation
What projects, programs and fundraisers would you like the Club to consider?

Payment

Total Due $
Payment Method

Cardholder Information

*Payment Method
*Card Number
*CVCC Security Code
*Card Expiration Month
*Card Expiration Year
*First Name
*Last Name
Billing Address
Billing City
Billing State/Province
Billing Zipcode
Billing Country
Comments / Questions

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