Name:

Mailing Address:

Email Address:

Home Phone:

Mobile Phone:

Work Phone:

Employer:

Job Title:

Spouse:

Anniversary:

Birthday (MM/DD):

Your Optimist Sponsor:

(please list the Optimist Club Member that referred you to our club) :

Membership Type:

Regular Member: a member who attends meetings regularly and is active with club activities.

Associate member: a who is unable to attend regular meetings but would like to continue to support the club financially and stay informed of activities.

Regular memberAssociate Member

Select a shirt type and size:

Each new member receives an Optimist Logo shirt. Please select the shirt type and size you woudl like.

Shirt Type:
Optimist Men's PoloOptimist Women's Polo

Men's Shirt Size:
Men's Size XXLMen's Size XLMen's Size LMen's Size MMen's Size S

Women's Shirt Size:
Women's Size XXLWomen's Size XLWomen's Size LWomen's Size MWomen's Size S

Comments (optional):