Membership Application

Jim Dandy Ski Club
P.O. Box 32706
Detroit, MI 48232
24 Hour Hotline (313) 345-8997

NBS Partner ID#

Ski Season

Individual New $70.00	30 & Under New $40.00	Family New $85.00	Silver Member $25.00	Family with 2 Silver Member $50.00
Ind. Renewal $60.00	30 & Under Renewal $30.00	Family Renewal $75.00	Family with 1 Silver Member $62.50	Late Fees $10.00

Family Membership is defined as:	(1) Two Married Adults and/or their Dependent Children
	(2) A Single Adult and Dependent Children

(Please fill in all information below from your computer keyboard and print the form in portrait mode)

Male:

(First Name, Middle Initial, Last Name)

Female:

(First Name, Middle Initial, Last Name)

Name:

Address:

City:

State: Zip Code

Home Phone:	Work Phone:	Birthday:

Name:

Address:

City:

State: Zip Code

Home Phone:	Work Phone:	Birthday:

E-Mail:

Check appropriate code(s) for each category

Novice

Intermediate

Expert

Skiing Ability:

Beginner

Advance Intermediate

Elite

Advance Beginner

Advanced

Instructor

Skiing Interest:

Alpine (Downhill)

Nordic (Cross Country)

Snowboard

Fundraising

Ski Better

Summer Social

Committee Interest:

Membership

Hospitality

Youth

Racing

Trip

Other

Dependent Children (Age 17 & Under)

Name	Birth Date	Name	Birth Date

Signature:

Date:

Emergency Contact:

Relationship:

Phone:

Referred/Recommended By:

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