Sacramento SC

Sacramento Social Club

Zigg President

MakenMoves vp

Lokii Sgt@arms

Mary Jane Business Mgr

Mz. DontPlay Secretary

Member Application

Information

Name: (required)

Current Address: (required)

State and Zip: (required)

Date of birth (required)

Phone: (required)

City: (required)

Email: (required)

Employment Information

Current employer: (required)

City: (required)

How Long?:

Position:

Employer Address

State and Zip: (required)

Phone: (required)

Emergency Contact Information

Name of a relative not residing with you: (required)

City: (required)

Relationship: (required)

Address: (required)

State and Zip: (required)

References

Name: (required)

Phone: (required)

Address:

Nickname: (required)

Signatures

I authorize the verification of the information. I have received a copy of this application.

Type signature of applicant: (required)

Date: