Application

H-Town Renegades
Website address: www.htownrenegades.blogspot.com 
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E-mail address: htownrenegades@yahoo.com
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Mailing address: 7721-A W. Belfort Box 195 / Houston, Tx 77071-444
Membership Form
H-Town Renegades Ski Club, Inc.
Membership Form
H-town Renegades Ski Club was organized on June 27, 1999 to educate and promote skiing activities within the African American Community. Annual dues are $50.00. Please make checks or money to:
H-Town Renegades Ski Club / 7721-A W. Belfort Box 195 / Houston, Tx 77071-1444
Name:_____________________________ DOB__________ T-Shirt = S, M, L, XL, 2X, 3X
Spouse:____________________________ DOB__________ T-Shirt = S, M, L, XL, 2X, 3X
Address:_____________________________City:___________ State:______ Zip:________
Home:(_____)_______________Work:(______)___________Cell( _____)______________________
Email :____________________________
Adress:_____________________________________________________________________________
Children Names: Ages: DOB:
_________________________________________ ________________ ____________
_________________________________________ ________________ ____________
_________________________________________ ________________ ____________
Address if different:_____________________________________________________________________________
Would you like for your name and contact information to appear in the Renegades Phone Directory? Y or N
Would you like to be interviewed for the “Bio” section of the Renegades Newsletter? Y or N
Would you like to volunteer to serve on a committee? If so, please select an area of interest:
_________Activities/Fundraising __________Trip Planning ________Pot Luck Dinners
_________Membership __________Public Relations ________Youth Events
Any medical conditions:__________________________________________________________________
Signature______________________________________________ Date_________________________
Signature______________________________________________ Date_________________________
Membership Type (check one ) :
New_______________ Renewal___________________ Change of Address______________________
Single Membership ($50.00)________ Family Membership ($75.00)_______ Associate Membership
($25.00)_______
(Family is defined as applicant and spouse and their children)
Level of Skiing: Never Ever________Greens________Blues_________Blacks________Extreme_________
Snow Boarder? Yes____ No____ Referred by:___________
_R____en__eg_a_d__e _B_o_a_r_d_ _U_s_e_ O_n_l_y_: _ __ Waiver Received:
Date of Payment: ______________ Check No.:_________
Check Amt: _____________ Database Updated: