Over the Hill Gang, International Membership Renewal

Print this page and complete the renewal form, then fax (719-389-0024) or mail to:
Over The Hill Gang International
1515 North Tejon Street
Colorado Springs, CO 80907

Member Number __________________________ Phone ______________________
Member Name __________________________ Birthday ______________________
Spouse Name __________________________ Birthday ______________________
Street Address __________________________ City ______________________
State __________________________ Zip Code ______________________
Email __________________________ FAX ______________________

Annual3 Year Life
(age 50-62) 		Life
(age 63+)
Individual Membership: $55 $115 $505 $335
Couple Membership: $95 $195 $850 $570

Need a Name Badge?   Please include $6 for 1 badge; 2 badges for $11
Name desired on badge: ____________________________Name desired on badge: ____________________________
City & State desired: _______________________________City & State desired: _______________________________

Check (made payable to OTHGI)      Visa      Mastercard      Amex

Credit card number _____________________________ Expiration Date _________________

     PLEASE KEEP YOUR CURRENT MEMBERSHIP CARD.     
We will send you a sticker indicating your renewal year.

Need a new member card?    Please include $5 for 1, $9 for 2.
Name___________________________ Name___________________________

IMPORTANT! TO COMPLETE YOUR RENEWAL, PLEASE READ AND SIGN THIS RELEASE!
Over The Hill Gang, International®is a year-round social and sports organization providing a variety of activities for members. The activities are, to varying degrees, hazardous. By making this application for membership, I voluntarily assume the risks involved. By assuming all risks involved, I agree not to hold the Over The Hill Gang, International®, its officers, board members, employees, agents, or members liable for any accident or injury resulting from my participation in an Over The Hill Gang, International® activity. Membership dues are not refundable. I hereby apply for membership renewal for Over The Hill Gang, International®.
 
   Signature of Member: _____________________________________________ Date: _______________
   Signature of Spouse: ______________________________________________ Date: _______________

Please be sure to sign this form on the lines marked
OTHGI can be reached at 719-389-0022  or  info@othgi.com