Florida Panthers Booster Club

Membership Application

FLORIDA PANTHERS BOOSTER CLUB

MEMBERSHIP APPLICATION

*Registration Date *Application Type
New Renewal New Member Coupon Code#? *Name(s) *Address *City / State / Zipcode *Home Phone Work Phone Cell Phone Email Address Date of Birth(s) Are you a season ticket holder?
Yes No Section / Row / Seat(s) Referred By

Membership Fees

Adult Fee = $20.00 per person

Family Fee (2 or more family members)
Adults = $15.00 per person

Out of State = $10.00 per person

*Will you be paying by Credit Card or Paypal?
Yes No

PLEASE NOTE
Membership Application is not valid without payment.

If paying by Credit Card or Paypal Account there will be an additional charge of $3.00 per member added to membership fee and an invoice will be sent to you by email.

Please include any additional members name & email address that you are paying for in the comment field.

If paying by check please make checks payable to:

Florida Panthers Booster Club
P.O. Box 551797
Ft. Lauderdale, FL 33355-1797

Comments

Florida Panthers Booster Club

est. 1999

Membership Application