Membership Form

$15 Single and $25 Family Membership

Checks payable to: Space Coast Jet Riders

Send membership form and check to:
C/O
Brooks Jones
PO Box 360095
Melbourne, Fl 32936-0095

 

First Name:
____________________________
Date:
_______________________
Last Name:
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Spouse:
____________________________
Child #1:
____________________________
Age:
________
Child #2:
____________________________
Age:
________
Child #3:
____________________________
Age:
________
Address:
______________________________________________________________
City:
____________________________
State:
______
Zip:_________
Home Phone:
____________________________
Cell Phone:
_______________________
E-mail:
____________________________
Work Phone:
_______________________
Personal Watercraft Information
Yr/Make/Model:
______________________________________
Yr/Make/Model:
______________________________________
Yr/Make/Model:
______________________________________
 Signature:
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