Square and Circle Club

Application for Membership

Name:_________________________________________________

Address:_______________________________________________

City: ___________________________________ZIP:____________

Phone: (____)___________________________________________

Email: _________________________________________________

Spouse’s name: _________________________________________

How did you learn about Square and Circle?

______________________________________________________

______________________________________________________

______________________________________________________

Please check areas of interest:­

____ Community Service

____ Scholarships

____ Fund Raising

____ Membership

____ Event Planning

____ Other:

______________________________________________________

______________________________________________________

______________________________________________________

Signature of Applicant _______________________________Date_______

Please send membership applications to:

Square and Circle Club
P.O. Box 640137
San Francisco, California 94164-0137