Astronaut Trail Shell
Club
Membership Application
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Name ___________________________________________________
Family members____________________________________________
Address _________________________________________________
City _______________________________Zip Code______________
Phone number ( ) ________________________________
E-Mail _____________________________________________
Main interests _____________________________________________________________________________________________________
Alternate address & Phone for seasonal members;
From (date)_________________ - To (date)___________________
Address__________________________________________________
City_______________________________ Zip Code______________
Phone ( ) _________________________________________
Annual dues $10.00/yr for Individual member or $12.50/yr for FamilyMembership type: Family_____ or Individual ______
[A family may include husband, wife and unmarried children
living in the same household]
Please print and remit this form with check for dues to:Astronaut Trail Shell Club
c/o Doris Underwood
698 Sheridan Woods Drive
West Melbourne, FL 32904