Midland Curling Club
2007-2008 Curling Payment Form
(one form per family)
Date Paid: _________________________
Family Name: ________________________ Home Phone: _______________________
Fees: Fee per membership form attached $ __________ C
Fee per membership form attached __________ C
Fee per membership form attached __________ C
Tax Deductible Contribution to Curling Club __________ D
Fee if pay by Visa/Mastercard $2.00 ___________E
Total Fees (C+D+E) $ F
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Method of Payment (for F):
___ Cash
___ Check (Payable to Midland Community Center)
___ VISA # _______________________________________ Expires: __________
Signature: ________________________________________