APPLICATION FOR ENROLLMENT IN THE BURSE CLUB
Name__________________________________________________________
Address________________________________________________________
City__________Zip________ Parish_________________________________
_____ I prefer to pay dues annually and
enclose $12
_____ I prefer to pay dues monthly and
enclose $1 for the month of
_______
____
I enclose an additional gift of $_____
Please make check payable to: D.C.C.W. Burse Club
Return to Parish Burse Club Director
or Mail to:
D.C.C.W. Burse Club
Post Office Drawer 17329
Pensacola, FL 32522-7329