BUFFALO SQUASH RACQUETS ASSOCIATION

MEMBERSHIP FORM – 2006-2007

BUFFALO SQUASH RACQUETS ASSOCIATION

MEMBERHIP FORM – 2006-2007

NAME: _____________________________________Date of Birth: ______________

ADDRESS: ______________________________________________

______________________________________________

Phone: H: _________________________

Phone: B: _________________________

Phone: C: __________________________

E-MAIL ADDRESS: __________________________________

CLUB AFFILIATION: ______________________________

Please bill dues through club or school: _______

(Only Saturn, BC and T&S Club, or School, Members )

Type of BSRA Membership:

Club Affiliated BSRA Memberships

Individual ($80): ______________________

Junior ($60)_____________________

USSRA Life ($35): ______________________

Non-Club Affiliated BSRA Memberships

Individual ($135): ______________________

Junior ($110): ______________________

USSRA Life Members($85):_______________

(Because Non-club affiliated members cannot host any matches, they are charged an additional $50.00 for a court usage fee-to be distributed among participating clubs).

Make checks payable to the B.S.R.A.

PLEASE RETURN TO:

Mary Sellers-Pici

48 Henning Drive

Orchard Park, N.Y. 14127

Phone: (716)662-0120

Email: mary.pici@adelphia.net