Philadelphia Phantoms Phan Club
Membership Application

(Membership Year runs from October 1st to September 30th)

No Refund on Membership Dues

Just complete the form below. Click on "Submit" when ready to send.
Or right click to download Membership Application.

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What type of application is this?

PLEASE INDICATE TYPE OF MEMBERSHIP PREFERRED.
Children under 5 years old are Free!

	Senior Membership (60 years and over) $5.00 per year, $8.00 after Labor Day
	Adult Membership (18 years up to 60) $12.00 per year, $15.00 after Labor Day
	Junior Membership (5 years up to 18) $5.00 per year, $8.00 after Labor Day All Junior Members need an Adult Sponsor!!
	Family Membership (2 adults + children ages 5 up to 18) $30.00 per year, $40.00 after Labor Day

Please complete the following information.

Your name:
Address:
City:
State:
Zip Code:
Telephone:
Date of Birth:
Email address:
Email address: (2nd Adult)

Please list the names and dates of birth for additional family members.

Name:		Date of Birth:
Name:		Date of Birth:
Name:		Date of Birth:
Name:		Date of Birth:

I will pay for this membership via mail or at the Phan Club table.

Any comments?

After submitting this form, you will be returned to the home page.

Mail payment to:
Philadelphia Phantoms Phan Club
P.O. Box 52232
Philadelphia, PA 19115-9998
Or drop off at the Phan Club Table during home games

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Philadelphia Phantoms Phan Club Membership Application