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.
For Charger - Churchill membership levels, an email will be sent for you to choose your membership perk

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 *

Churchill $1000 - Fleece Jacket, Puffer or Backpack Winston $500 - Vest, Jacket or Cooler Charger $200 - Tshirt or Hat Black $100 - website recognition 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 *