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    $12.50/yr for Individual member  or $15.00/yr for Family

Membership 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  Mrs. Doris Underwood, 
7529 Ensemble Lane, Melbourne, FL 32940
Phone: (321) 622-4372    e-mail: 
dunderwood1@cfl.rr.com

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