2008 Kids Club Membership Form	Presented by
		and

Please complete form and print.

To join by fax as a "Big Fan" or "Super Fan" member, please fax with credit card information (space provided on form) to 417-863-1026, or mail form to 2006 Lasers Kids Club , 1923 N. Weller, Springfield, MO 65803. , supply credit card information or enclose a check for the appropriate membership fee, payable to:

Springfield-Greene County Park Board
1923 N. Weller
Springfield, MO 65803.

Join as a "Fan" for FREE, "Big Fan for $10", or "Super Fan for $25". "Big Fan" and "Super Fan" memberships include additional benefits!

* indicates required information
Select Type Membership:*	Fan - Free Big Fan - $10 Super Fan - $25
Child's Name*	Age
Parent's Name*
Address*
City*
State*	Zip*
E-mail Address
Day Phone*	Evening Phone Mobile Phone
Visa Mastercard Discover CardAcct. No. Exp. Date
Parent's address if different:
Name
Address
City	State Zip

If you have any questions call 417-864-1339. Welcome to the Lasers Kids Club!