Membership Registration

MEMBERSHIP REGISTRATION FORM:

After completion of this form, please select "SUBMIT" and you will be directed to the online/mail in payment page.

MEMBER INFORMATION

* Indicates required field

Name *

First

Last

Spouse's Name *

First

Last

Home Phone *

Cell Phone *

ALUMNI *

Address *

Zip Code *

Contact Email *

Alternate Email *

Membership Type (Note-Ads must be placed prior to 7/30 to be in All Sports Program!) *

Churchill $1000 Website Recognition, WC CSA Member Decal, Sports Program Recognition, Full Page Ad OR two stadium seats. Winston $500 Website Recognition, WC CSA Member Decal, Sports Program Recognition, 1/2 Page Ad OR one stadium seat Corporate $350 Website Recognition, WC CSA Member Decal, Sports Program Recognition, 1/4 Page Ad OR a WC shirt Elite $200 Website Recognition WC CSA Member Decal, Sports Program Recognition, 1/8 Page Ad OR a WC hat Charger $100 Website Recognition, WC CSA Member Decal, Sports Program Recognition Black $50 Website Recognition, WC CSA Member Decal Red $25 Website Recognition

Payment Method *

Online Mail in

STUDENT 1 INFORMATION

Special Note-
ALUMNI WITHOUT A CURRENT CHURCHILL ATHLETE DO NOT HAVE TO FILL OUT THE STUDENT INFORMATION
Thank you!

STUDENT 2 INFORMATION

STUDENT 3 INFORMATION

Additional Comments *