Application | Sioux Valley Optimist Club

Membership Application

Contact Information

First name

Last name

Sex/Gender

This is for Optimist International volunteer demographic reporting purposes only.

Multi-line address

Country/Region

Address

City

Zip / Postal code

Phone

Employer Information

Employer Name

Position/Title

Birthdate

Birthday Month

Birthday Day

T-Shirt & Name Tag Information

With your membership, you receive a complimentary SVOC volunteer shirt and name tag.

T-Shirt Size

Name for Badge

Enter your name exactly as you'd like it to appear on your name badge.

How Did You Hear about the SVOC?

Referral Source

What Interests You in Joining the SVOC?

Answer here.

Preferred Payment Method

Annual membership dues are $100 and are prorated based on when you join during our club year (October through September). We believe everyone should have the opportunity to serve. If the cost of membership presents hardship, please contact the SVOC President to discuss available options.

I understand membership dues are required for membership and will be collected after my application is approved.

I acknowledge that individuals who have committed sexual offenses against children may be denied membership and/or have membership revoked.

Electronic Signature

By typing your full name below, you certify that the information provided is accurate and acknowledge acceptance of this application.

Signature

Date Signed