Membership Form 2006-07

Membership Fee:  $12.00 per Adult Member
Youth Memberships FREE with Parent Adult Membership
Complete the application and submit with payment of dues 
(please print) to the following address:  
W-B/Scr. Penguins Booster Club
P.O. Box 419
Wilkes-Barre, PA 18703-0419
ATTN:  Membership

Checks should be made payable to WB/S Penguins Booster Club.

1st Adult Membership:

Name:  ___________________________________________________
Address:  _________________________________________________
City:  ______________________  State:  _______  Zip:  ___________
Birthday: (month/day)  _____________ Home Phone: _______________  
E-mail Address:  ____________________________________________
Would you like to be a Booster Club volunteer?  (y)  (n)  circle one
Are you a season ticket holder?  (y)  (n)  circle one

2nd Adult Membership:

Name:  ___________________________________________________
Address:  _________________________________________________
City:  ______________________  State:  _______  Zip:  ___________
Birthday: (month/day)  __________ Home Phone: __________________  
E-mail Address:  ____________________________________________
Would you like to be a Booster Club volunteer?  (y)  (n)  circle one
Are you a season ticket holder?  (y)  (n)  circle one

Youth Membership:

(Family members under 18 years of age.  Parent or guardian MUST be an adult member.)
Name:  ___________________________ Birthday:  ______________________________
Name:  ___________________________ Birthday:  ______________________________
Name:  ___________________________ Birthday:  ______________________________
Name:  ___________________________ Birthday:  ______________________________

Additionally: 
 (___)   I would like to have access to the newsletter online