Club Dues

Complete Name of Club *

Date *

Fiscal Year (July) *

President

Name *

Email *

Phone *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Treasurer

Name *

Email *

Phone *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Required Annual Contributions for Senior Clubs

Active Members *

Member Dues

$

Outgoing National President's Award (NFMC)

OFMC Young Artist Fund (OFMC)

Total Required Dues

Other Contributions

Founders Day

Total

$

Life Members for National Magazine

Total

Honorary Members or Extra Club Magazines

Total

$

Memorial Gifts

Total

Given by

Given to

In Honor/Memory of

Total Other Contributions

Total Dues and Contributions

Billing Information

Name *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Credit / Debit Card *

Senior Club Statement of Dues

President

Treasurer