Member Information Worksheet

Vandalia-Butler Optimist Club Member Information

Please fill out all the fields below, then click the "Submit" button.
Choosing "Reset" will clear the form.

Optimist Member Name:   
Spouse's Name:

Street Address:   
City:    Zip: 

Home Phone:  () -    Work Phone:  () - ext:

Cell Phone: () -        Fax Number: () -    
 
Email Address: 

Member's Birthday:  /   (Month/Day)

Previous event involvement:

What do you like about our club right now:

What do we need to improve upon right now: 

I am interested in working on a particular club function:  *Yes     No
    *If "Yes," please list interests: 

I would consider being an officer of the club sometime in the future:  Yes     No

Other comments: