Optimists Club Member Application | Farmington - Farmington Hills Optimist Club

Optimist Club Member Application

This form is for adults joining the Optimist Club. Junior Optimists, please use the blue button to apply.

Junior Optimist should use the blue button above to submit a Junior Optimist Application

Name(Required)

First Last

Were you ever a Junior Optimist Member?(Required)

Yes

Are you currently a full-time college student?(Required)

Yes

Home Address(Required)

Physical Address, not a PO Box

Street Address City State ZIP Code

Cell Phone

Home Phone

Email(Required)

Work Phone

Date of Birth

Sponsor

(if any)

First Last

Please note:
Individuals who have committed sexual offenses against children may be denied membership and/or have their membership revoked.

Signature(Required)

Use your mouse on desktop or use your finger on cell or tablet to sign your application.

Membership Dues (Select One)(Required)

Annual Dues

Quarterly Dues

Total

Credit Card(Required)

Card Details

Cardholder Name

Phone

This field is for validation purposes and should be left unchanged.