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 *

Churchill $1000 Sports Program Advertisement Full Page ** Winston $500 Sports Program Advertisement 1/2 page ** Corporate $350 Sports Program Advertisement 1/4 page ** Elite $200 Website, WC CSA Decal and Program Recognition 1/8 page ** Charger $100 Website, WC CSA Decal, Sports Program Recognition ** Black $50 Website, 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 *