H2OUNDS CLUB MEMBERSHIP FORM Contact Information NAME: _____________________________________________________________ ADDRESS: __________________________________________________________ City, State, ZIP: ______________________________________________________ PHONE: ______________________ EMAIL: ______________________________ I would like to join The H2OUNDS CLUB at the: _______ 1650 Yard Level - $1,650 – Participation at the $1,650 Level includes a $1,500 tax-deductible charitable gift; the remainder is payment for the specific benefits listed. _______ 1000 Yard/3 Meter Diving Level - $1000 - Participation at the $1000 Level includes a $850 tax-deductible charitable gift; the remainder is payment for the specific benefits listed. _______ 500 Yard Level - $500 - Participation at the $500 Level includes a $400 tax-deductible charitable gift; the remainder is payment for the specific benefits listed. _______ 200 Yard/1 Meter Diving Level - $200 – Participation at the $200 Level includes a $150 tax-deductible charitable gift; the remainder is payment for the specific benefits listed. _______ Young Alumni Sprint Club - 100 Yard Level - $100 – Participation at the $100 Level includes a $75 tax-deductible charitable gift; the remainder is payment for the specific benefits listed. *Designed exclusively for alumni that graduated in the previous 3 years (’05, ’06,’07)* Credit Card Information Credit Card (Visa, MC, AMEX, Discover) exp date Please charge my credit card for the amount indicated in the member level chosen above. Signature Date Please return this completed form in the enclosed business reply envelope or fax to 410-617-5133. Checks are payable to Loyola College – Swimming & Diving - 4501 North Charles Street – Baltimore MD 21210 For any additional information please contact Chris McFarlane at 410-617-5409. | 
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