MEMBERSHIP APPLICATION

     Please, fill out the following questionnaire on how to become or renew your membership as an official member
 of the Den of Lions Sports Academy.
                      Membership Fees:  Men $40,  Women $20, Den of Lions Athlete $10.

     Name      
     New Member  Yes    No      (if No)  -- Member Number 

               Address   
               City            State  Zip 

     Phone (home)    Cell 

               E-Mail      Married:   Yes    No

     Number of Kids      Occupation 
     Paying Membership for:   2006  '07  '08  '09  '10

This information will be part of our database in order to create a better relationship with our members.

 Check payable to:
    Lar dos Leões de New Jersey

Once filled, please send it to:

Lar dos Leões de New Jersey
Att. Secretaria
18-20 Gotthart St.
Newark, N.J. 07105