Membership Form

$20 Single and $25 Family Membership

Checks payable to: Space Coast Jet Riders

Send membership form and check to:
Space Coast Jet Riders
c/o John Kerekes, Treasurer
3829 St. Armens Circle, Melbourne, FL 32934

 
First Name:
____________________________
Date:
 _______________________
Last Name:
____________________________
Spouse:
____________________________
Child #1:
____________________________
Age:
________
Child #2:
____________________________
Age:
________
Child #3:
____________________________
Age:
________
Address:
 ______________________________________________________________
City:
____________________________
State:
______
 Zip:_________
Home Phone:
____________________________
Cell Phone:
_______________________
E-mail:
____________________________
Work Phone:
_______________________
Personal Watercraft Information
Yr/Make/Model:
______________________________________
Yr/Make/Model:
______________________________________
Yr/Make/Model:
______________________________________
 Signature:
______________________________________