The Exchange Club of
APPLICATION FOR MEMBERSHIP
Name of Applicant___________________________________________________ Age______________________
Address (Business)_______________________________________ Zip__________ Phone____________________
Address
(Home)_________________________________________ Zip__________ Phone____________________
Email Address______________________________________________ Cell Phone (optional)
____________________
Preferred Mailing Address for Notices: Email ___ Home ___ Business____
Preferred Mailing Address for Invoices : Home ___ Business____
Occupation___________________________________________________________________________________
Married (Yes/No)_________
Spouse's Name_____________________________ No. Children______________
City of Residence prior to coming
to Tampa________________________________________________________
Prior member of
Exchange Club?________________________________ Where_______________________________
Other Memberships: (Fraternal organizations, civic clubs, fraternity/sorority, church, etc)_____________________________________________________________________________________________
Friends now in Exchange Club
(name two)_________________________________________________________
_____________________________________________________________________________________________
Proposed By: (1)____________________________________________________________________________
(2)____________________________________________________________________________
Please return to:
The Exchange Club of
75 Years of Service