“M CLUB” DUES AND STADIUM BRICK APPLICATION PARTICIPANTS NAME____________________________________ SOCIAL SECURITY NUMBER________________________________ HOME PHONE_______________BUSINESS PHONE______________ YEAR/YEARS OF PARTICIPATION____________________________ SPOUSE OF PARTICIPANT__________________________________ DECEASED NAME________________________________________ MEMORIAL MEMBERSHIP_________BRICK PARTICIPATION________ YEAR DECEASED_________________________________________ SPOUSE OF DECEASED_____________________________________ DONOR IF OTHER THAN PARTICIPANT________________________ AMOUNT ADMITTED WITH APPLICATION $___________________.00

  AMOUNT FOR BRICK          $100.00 DUES - RENEWAL                    $25.00 DUES - NEW MEMBER            $25.00 CONTRIBUTION TOTAL            $_______.00 IF YOU ARE A NEW MEMBER, WE WILL MAIL YOUR CERTIFICATE AND MEMBERSHIP CARD TO YOU. IF YOU ARE A “M” CLUB MEMBER, YOU WILL RECEIVE A STICKER FOR YOUR CURRENT MEMBERSHIP CARD    

MARSHALL UNIVERSITY POST OFFICE BOX 1360 HUNTINGTON, WV 25715

RALPH MAY, PRESIDENT (304) 696-3978 OFFICE (304) 743-0797 HOME (304) 696-2325 FAX

 
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