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.

PARENT INFORMATION

* Indicates required field

Name *

First

Last

Home Phone *

Cell Phone *

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 Winston $500 Website Recognition, WC CSA Member Decal, Sports Program Recognition, 1/2 Page Ad Corporate $350 Website Recognition, WC CSA Member Decal, Sports Program Recognition, 1/4 Page Ad Elite $200 Website Recognition WC CSA Member Decal, Sports Program Recognition, 1/8 Page Ad 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-
Individuals joining without an athlete attending Churchill High School, please fill in the following required fields with:
Name- Go Chargers, M/F- na, Grade Level- na, Sport-na. Thank you!

STUDENT 2 INFORMATION

STUDENT 3 INFORMATION

Additional Comments *