2012 Residency Renewal

St MinneSomePlace In Paradise

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Residency Renewal Application

2012 RESIDENCY RENEWAL APPLICATION

To maintain your lone palm on the island of St. MinneSomePlace and continue to reside among the many other crazy Parrots Heads down island, please complete the renewal application below. All members were also mailed a renewal application as well.

As you know, there are three types of annual memberships and an individual or couple annual membership....see descriptions below.
So decide how involved you want to be and retain you lone palm on the island!

St MinneSomePlace membership is $25 dollars for individuals and $35 dollars per year for couples.

Renewals are due by Jan 31, 2012.
After March 31, non-renewals will be considered as haven hit landfall.
To remain current and well-informed of club activities and all things Buffett, please renew by Jan.31.

After submitting this form you will be contacted confirming your renewal.
Checks can be made out to St. MinneSomePlace and mailed to:

St MinneSomePlace in Paradise
PO Box 1201
Maple Grove, MN 55311-6201

or

Payment by credit card can be made by PayPal...see instructions below.

If your personal information has changed over the past year, please provide updates below

Or you may download and print either of two forms:
Download and Print Blank Form

2012 Residency Renewal

If applying for more than one person, please select each person's membership preference, either Adm, Active, or Social.

NOTE: When you have finished your application, click on the "Phins Up" button to send your application to the Membership Bwana. You will receive a confirmation email shortly. You will be directed to the PayPal page when you click on "Phins Up". If you have elected to pay by check, please just click out of the PayPal page.

In case you are wondering, this payment is not tax deductible as a charitable contribution for federal tax purposes.All other donations are tax deductible, as this funding is dedicated to community service efforts rather than operational expense of our organization.

Date:
Member Since:
Membership (1): *
Membership (2):
First Name (1): *
Last Name (1): *
First Name (2):
Last Name (2):
Address (Street): *
City: *
State: *
Zip Code: *	(5 digits)
Daytime Phone:
Evening Phone:
Email (Personal): *
Email (Additional):
Email (Additional):
Permission to Share Email Address: *	Your email will be used for all St MSP correspondence
Occupation/Company:
Birthdate (MM/DD):
Children, Ages:
Age Group: *
With what projects would you like to help in 2012:
Suggestions for St MSP:
Comments, 2011:
Suggestions for 2012:
Payment: *