Please print this page and mail or fax completed form to:

Charlotte Economics Club, Inc.
P.O. Box 49394
Charlotte, NC 28277
Fax: 704-319-2289

CHARLOTTE ECONOMICS CLUB MEMBERSHIP APPLICATION 2008 -2009

NAME__________________________________________________________________  

              (First)              (Nickname)            (MI)               (Last)

 TITLE____________________________________________________________________  

COMPANY______________________________________________________________  

ADDRESS________________________________________________________________  

CITY: ______________________________ST :___________________ZIP_____________  

OFFICE PHONE: ___________________________

 HOME PHONE: ____________________________ 

FAX: _____________________________________

CELL PHONE: ______________________________

EMAIL: ___________________________________

 _____ Dues $100.00 for membership through December 2009 for new members

 _____ PREPAY MEETINGS AT $330.00 FOR TEN MEETINGS

____CHECK ENCLOSED PAYABLE TO CHARLOTTE ECONOMICS CLUB

 ____VISA _____MC #______________________________________  Exp. Date:_____  

TOTAL TO BE CHARGED: _______________

NAME ON CARD:________________________________________________________

  SIGNATURE: ____________________________________________________________