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

Child's name and address

First name:

Last name:

Street 1:

Street 2:

City:

State:

* Zip: *

Cell phone:

Home phone:

Email address:

T-Shirt size:

Child's Date of Birth and Age

Date of birth:

Age:

Gender:

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)