The Pocono Mountains Magic Club
Online Membership Application
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Name In Full :
Professional Name :
Address :
City :
State :
Zip Code :
Home Phone :
Business Phone :
Cell/Alt Phone :
Date Of Birth :
E-Mail Address :
Web Site (If Any) :
Business Or Profession :
A Brief History Of Your Interest In Magic :
Are You A :
All
Professional
Semi-Pro
Amateur
Hobbyist
Collector
Dealer
List Any Other Magical Organizations You Belong To (One Per Line Please) :
I Am Applying For Membership As A :
Not A Member Of Either Organization Yet
Member Of Both Organizations
Member Of The International Brotherhood Of Magicians
Member Of The Society Of American Magicians
Please List National Membership Numbers (If Any) :
I hereby apply for membership in the "Pocono Mountains Magic Club" as an IBM or SAM national member as indicated above. I will abide by the Constitution and By-Laws of this club as well as by those governed by the national organizations. I submit the required dues for membership. (Annual dues "Jan-Dec" of $15.00 per person renewable every January) Dues shall be refunded if my application is rejected.
Applicants Digital Signature (Information will be transcribed to a formal written application. This application is not considered binding until dues are paid and the application is accepted by the "Pocono Mountains Magic Club") :
NOTE: This information will only be sent to the officers of the "Pocono Mountians Magic Club" and is intended for the sole use in collecting membership application information. No part of this information may be shared with any parties outside the "Pocono Mountains Magic Club" and the applicant has the full right to withdraw his application at any time.