Clan McFritz

Membership

Life Time Membership Application Form

First Name: _______________________________M.I.: ____  Last Name: _______________________

Occupation: __________________________________________

Spouse: ________________________________ M.I.: ________

Address: _______________________________________________________________ Apt: _______

City: _____________________________________________ State: ______ Zip: _________________

Home Phone: ______________________________

E-mail: ____________________________________________________________________________

Date of Application: ________________________________

Per Member: $19.95

Enclose Check or Money Order Payable To Robert G. Schweitzer

Mail To:

Clan McFritz

1207 Girard Drive

Louisville, KY 40222