MSU Gulf Coast Booster Club Annual Membership Form

For the period from August 1999 to August 2000

________ Single Person ($25)

________ Family (Immediate, $35 -- Please list family members below)

________ Donation -- Amount $________

Name: _____________________________________________________________

Address:_________________________ City___________ State______ Zip______

Home Phone:_____________________ Work Phone:________________________

Additional Family Members:

1.______________________

2.______________________

3.______________________

Mail Membership Form To:
Todd Stennis
5315 Lawson Avenue
Gulfport, MS. 39501

Please make checks payable to: MSU Gulf Coast Booster Club

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