Men's Club New Member Registration

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Home Phone Number (xxx) xxx-xxxx

Email Address *

Cell Phone Number (xxx) xxx-xxxx *

Spouse Name *

Name to be shown on name tag *

Men's Club Shirt ($25) *

Occupation *

Referred by *

Are you a parishioner of Good Shepherd? *

Yes

No