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