Chippewa Falls Optimist Club Membership Application
Hello!  We are excited to have you join us in service to bring out the best in youth, our communities and ourselves.

This form is used to gather some information to learn a little about you for your membership in our local Chippewa Falls Optimist Club.  Your local membership also includes membership in Optimist International.

Membership dues are $35 per year. Click the "Pay Now" button at the end of this form to pay your yearly dues.

Email *
Today's Date *
MM
/
DD
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YYYY
Your First Name *
Your Last Name *
Do you have a nickname you'd like to be addressed by?
Your Birthday MM/DD (so we can celebrate you!) *
Address *
City  *
State  *
Zip Code *
Preferred Phone Number for contacting you (please indicate if this is a cell phone number) *
Preferred Email Address *
If there is a current Optimist Club member who invited you or encouraged you to join this club, please share their name.
Your typed name here indicates your acceptance of this membership application.
 *
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