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MSU Hockey

Membership Application

Please print this form on your computer, fill out the form, then send the form and a check to:
MSU Blue Line Club, PO Box 804, East Lansing, MI 48826-0804
Make check payable to "MSU Blue Line Club."
Note: If this prints out as a two-page form on your computer's printer, please be sure to send us BOTH sheets. Thank you.

PLEASE PRINT VERY CAREFULLY

NAME:
ADDRESS:
CITY, STATE, ZIP CODE:
DAYTIME PHONE NUMBER (with Area Code):
EMAIL ADDRESS (Please PRINT very carefully!):
This is a:   ____NEW membership     ____RENEWAL membership
DUES - Please indicate the appropriate rate:
  • STUDENT - Elementary, secondary, or post-secondary: $6.00 ____
  • SINGLE - Individual person: $25.00 ____
  • FAMILY - Married couple or one adult, plus children under 18 years old: $30.00 ____

    Names of family members:
NAME BADGE - Show your pride in your MSU Blue Line Club by ordering an attractive 3.5"x1.25" permanent name badge. This purchase is optional.

Names to be engraved on badges (First and Last Names... please PRINT very carefully):
  •  
  •  
  •  
  •  
Total number of badges ________ at $10 each = $________
OTHER OPTIONAL PURCHASES:
  • PINS from previous years: Years requested _____________ at $3 each $________

  • STICKERS from previous years: Years requested _____________ at $3 each $________
TOTAL AMOUNT ENCLOSED (Dues + any optional purchases): $________
TODAY'S DATE: