Blue Hen Basketball Club

Membership Form 2009-2010

Please supply the following information for club records. You information will not be used for any purposes other than club activities. For couples please provide both names.

NAME:

NAME:

ADDRESS:

CITY:

STATE: ZIP CODE:

PHONE NUMBERS:

HOME:

WORK:

CELL:

E-MAIL ADDRESS:

Cost of club is $25.00 per person.

Please send check made out to Blue Hen Basketball Club to P.O.Box 9803 Newark, DE 19714-4903

If you have any questions, please contact any board member

Thanks For Joining!!!! Return to Basketball Club Web Page