If you are interested in becoming a member, please print and fill out the form below and mail it to:
Miami Valley Browns Backers, P.O. Box 555, Piqua, Oh 45356
Miami Valley Browns Backers 2006 Application
Type of Membership: New_____ Renewal_____
Name(s):___________________________________
____________________________________
____________________________________
Address:____________________________________
_____________________________________
_____________________________________
Phone:_____________________________________
E-Mail:_____________________________________
Comments/Suggestions:________________________
_____________________________________________
_____________________________________________
Membership Dues: E-mail Membership (10 Dollars)
E-mail Family Membership (15 Dollars)
Non-Email Membership (15 Dollars)
Non-E-mail Family Membership (20 Dollars)
Date Paid:__________ Officers Inititals:__________
GO BROWNS!
