Membership Application Form

Asian American Club of the Villages

Membership year Jan. 2020 to Dec. 2020

$10 per person per membership year paid, $10 ( )

PLEASE PRINT

DATE:  _________________

Last name: ______________________________________________

First name: ______________________________________________

Name tag name: _______________  country of birth: _______________

Email address: ___________________________________________

Home phone number: ____________ cell phone number:____________

Local address: ___________________________________________

Village name: ____________________________________________

Sumter (  )  Lady Lake (  )  Marion (  )  Fruitland Park (  )  Wildwood (  )

Return completed form and payment to Morrie at:

Asian American Club    c/o: Morrie Mudrick           

2525 Five Forks Trail           

The Villages, Fl. 32162