
LOYOLA SOCCER CLUB MEMBERSHIP FORM Contact Information NAME: _____________________________________________________________ ADDRESS: __________________________________________________________ City, State, ZIP: ______________________________________________________ PHONE: ______________________ EMAIL: ______________________________ I would like to join The Loyola Soccer Club at the: _______ National Champion Level - $1,250 – Participation at the $1,250 National Champion Level includes a $1,000 tax-deductible charitable gift; the remainder is payment for the specific benefits listed. Gear Size _____ _______ All-American Level - $600 - Participation at the $600 All-American Level includes a $500 tax-deductible charitable gift; the remainder is payment for the specific benefits listed. Gear Size _____ _______ All-Conference Level - $300 - Participation at the $300 All-Conference Level includes a $250 tax-deductible charitable gift; the remainder is payment for the specific benefits listed. Gear Size _____ _______ Supporter Level - $125 – Participation at the $125 Supporter Level includes a $100 tax-deductible charitable gift; the remainder is payment for the specific benefits listed. Gear Size ___ 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
Checks are payable to Loyola College-Men’s Soccer-4501 North Charles Street-Baltimore MD 21210 For any additional information please contact Chris McFarlane at 410-617-5409. |