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Please print (pg.1 of 1) at 80%,
 
 
Name

Home Address
City


 		 State


 		 Zip
Home Phone (      )

 Cell Phone (      )
Married/Single/Divorced


 		 xxxxxSpouse's Name


 		 No. of Children
Company


 		 Occupation/Title
Business Address


 		 E-mail
City


 		 State


 		 Zip
Business Phone (      )


 		 Ext
.
 
 		             Fax (      )
Birth Date


 		       Birth Place
College/University

 No. of Years


 		 Year Grad.
Pro Team


 		 Position


 		 From 19          to 19
Pro Team


 		 Position


 		 From 19          to 19
Pro Team


 		 Position


 		 From 19          to 19
Pro Team


 		 Position


 		 From 19          to 19
Clubs and Organizations

Shirt Size


 		 M              L              XL              XXL              XXXL

 
       
Professional Membership
Available to former players, owners, coaches, administrators, cheerleaders or anyone ever paid by a professional major league team. Professional experience is subject to verification. Dues and initiation fees are tax deductible.

Initiation Fee..............$100 waived
Annual Dues.................$60
Total Amount Due............$60
 
 

  Associate Membership
Available to those who support the charitable and educational goals of the NFL Alumni. Dues and initiation fees are tax deductible.
 


Initiation Fee..............$100 waived
Annual Dues.................$120
Total Amount Due............$120
 
 

Amount Enclosed


 		 Chapter Affiliation Desired
Visa/MC#

 Expiration date
Applicant Signature


 		 Date
 
mail to:
National Football League Alumni Incorporated
National Headquarters 3696 N. Federal Hwy, Suite 202 Fort Lauderdale, Fl. 33308