NOTE: This form is ONLY for existing members of the P.A.L.S. Club program to renew membership

Child's name and address

Child's Date of Birth and Age

Club Membership Fee -- Method of payment

1) Check (mailed or in-person drop off)

2) Credit Card: Name, Card Number, Expiration Date, V-code, Billing Address

3) Cash (mailed or in-person drop off)