Fort Campbell Enlisted Spouses' Club 

Enlisted Spouse's Club 2009-2010

Membership Form

Aug. 19, 2009– Aug. 19, 2010

Date__________

Name___________________________________

Address_________________________________

Home Phone_____________________________

Cell Phone_______________________________

Email address____________________________

Birthday_________________________________

Anniversary Date_________________________

Spouse's Name___________________________

Spouse's Unit____________________________

Childres's Name/Age

_______________________________________

_______________________________________

_______________________________________

Special Interest or Hobbies_________________________________

Please circle any committees you are interested in participating in:

Hospitality        Publicity         Liaison         Welfare

Membership        Parliamentarian         Newsletter

Scholarship               Fundraising                  Other

Do you have any skills or talents you would be willing to share with our group? 

_______________________________________

_______________________________________

_______________________________________

I give my permission for my phone number and email address to be published in the Enlisted Spouses Contact roster: 

YES_____     NO_____

Signature_______________________________

Please use Paypal located on the Dues/Donations

to pay yearly dues or mail dues to:

ESC

POB 823

Fort Campbell,KY

42223

Highlight the Membership form to the left, right click and copy to a word doc, or click on this link to open a PDF Membership Form, complete and email to escftcky@yahoo.com or print and mail along with dues to:

ESC

POB 823

Fort Campbell, KY

42223