Single Renewal

Full Name:                      
Address:                          
City:                              
State:                             (example: IN)
ZIP:                               
E-mail Address:               
Phone:                             

Would you like to receive the newsletter
via e-mail or via regular mail?:               email mail

How are you paying?          at the next club event Paying ONLINE mailing check or money order

Please remember if mailing payment, mail to:

Girth & Mirth Indianapolis
5808 Westhaven Dr.
Indianapolis, IN 46254
 

Make all checks Payable to Girth  & Mirth Indianapolis

Couple/Same household Renewal

1st           partner/person name:               
2nd other partner/person name:               
Address:                                                          
City:                                                              
State:                                                             (example: IN)
ZIP:                                                              
E-mail Address:                                              
Phone:                                                            

Would you like to receive the newsletter
via e-mail or via regular mail?:               email mail

How are you paying?          at the next club event payed via paypal mailing check or money order

Please remember if mailing payment, mail to:

Girth & Mirth Indianapolis
5808 Westhaven Dr.
Indianapolis, IN 46254

Make all checks Payable to Girth  & Mirth Indianapolis