Please complete this form for membership in The Goofy Villagers.

Membership fees are $15 plus $6.50 for Name Badge – Total $21.50 for each person .

Mail check payable to TGV and mail check to:

Rose Nutley
1424 Olustee Place
The Villages, FL, 32163

Any questions or concerns, please state them in the Notes area.

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Information for Member #1:

First Name #1:*

Last Name #1:*

Email #1:*

Re-enter Email #1:*

Home Number #1:*

Cell Number for Member #1:

Villages ID Member #1:

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Information for Member #2 (If Applicable):

First Name #2:

Last Name #2:

Email #2:

Re-enter Email #2:

Home Phone #2:

Cell for Member #2:

Villages ID Member #2:

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Street Address in The Villages:*

Zip Code:*

Residing in the Village Of:*

Residence Status:*

Please Select Full Time Seasonal

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I have mailed my Check #*

on*

to the address listed above.

Notes:

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