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LOYOLA CREASE CLUB

MEMBERSHIP FORM

Contact Information

NAME: _____________________________________________________________

ADDRESS: __________________________________________________________

City, State, ZIP:  ­­­______________________________________________________

PHONE: ______________________            EMAIL: ______________________________

I would like to join The Loyola Crease Club at the:

_______   All-American Level - $750 – Participation at the $750 All-American Level includes a $500 tax-deductible charitable gift; the remainder is payment for the specific benefits listed.                                                                                 

_______   Tournament MVP Level - $500 - Participation at the $500 Tournament MVP Level includes a $350 tax-deductible charitable gift; the remainder is payment for the specific benefits listed.                                                                                 

_______   All-Conference Level - $250 - Participation at the $250 All-Conference Level includes a $175 tax-deductible charitable gift; the remainder is payment for the specific benefits listed.                                                                                 

_______   Starting Lineup Level - $100 – Participation at the $100 Starting Lineup Level includes a $75 tax-deductible charitable gift; the remainder is payment for the specific benefits listed.

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 by mail or fax to 410-617-5133.

Checks are payable to Loyola College – Women’s Lacrosse - 4501 North Charles Street –

Baltimore, MD 21210

For any additional information please contact Chris McFarlane at 410-617-5409.

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