SMITHFIELD  ATHLETIC  BOOSTER  CLUB  SMITHFIELD  HIGH  SCHOOL  

MEMBERSHIP  YEAR  2011/2012    DATE:  ___________________      MEMBERSHIP  FEE  IS  $5.00  PER  PERSON  PER  YEAR      #  OF  MEMBERS:  _______       TOTAL  AMOUNT:_________      Cash  Payment:  ________       Check  Payment:  Check  #  ___________    (Make  checks  payable  to  Smithfield  Athletic  Booster  Club)        MEMBER’S  NAME         EMAIL  (Please  print  clearly):  ______________________________   ____________________________  ______________________________   ____________________________  ______________________________   ____________________________    HOME  ADDRESS  _________________________________________________________  CITY  _________________________   ST_____     ZIP  _______________    HOME  PHONE  #  ________________   CELL  PHONE  #  ________________        LIST  OF  ALL  SMS/SHS  STUDENTS  IN  FAMILY:      ________________________________GRADE  ________  SPORT(S)  __________________    ________________________________GRADE  ________  SPORT(S)  __________________  ________________________________GRADE  ________  SPORT(S)  __________________  ________________________________GRADE  ________  SPORT(S)  __________________      Thank  you  for  your  support.    If  you  would  like  to  offer  your  time  and  talents  to  Smithfield  Athletic  Booster  Club,  please  consider  helping  with  the  following  committees:  (check  all  that  apply)    ____Board  member   ____  Concessions  (_____________for  which  sports  event?)  ____Fundraising     ____  Spirit  wear     ____Team  parent  rep   ____General  volunteer  ____Membership     ____Funds  Distribution   ____Banquets     ____Senior  recognition    Please  list  any  other  skills,  interests    or  talents:  ________________________________________________      My  company  is  interested  in  being  a  Corporate  Sponsor:  Yes            No          (Please  circle  one)    Mail  form  to:   Smithfield  Athletic  Booster  Club       P  O  Box  95       Smithfield  VA    23431-­‐0095        

FOR  OFFICIAL  SABC  USE  ONLY  Received  by:___________  Date  received:________    Received  by  membership:________