SKYDIVERS OVER SIXTY – S.O.S.

NAME:

Application date: ___________________

POPS #: ________________

 

Send Life-time membership fee:$10.00

To:

Pat Moorehead, SOS #1

3350 St. Francis Place

Long Beach, CA 90805-3854 USA

 

562-630-5229

skyfunone@aol.com

 

For office use only: SOS# _____________

Membership date:____________________

Dues Paid:$ ________________________

Additional US Team donation:$_________

Address:

City:

State/Province:

Country& Postal Code:

DATE OF BIRTH:

NUMBER OF JUMPS: (optional)