Flint Theatre Organ Club Membership Application

The information provided is used strictly for FTOC purposes and is not shared with third parties. Please include proper membership dues (written to Flint Theatre Organ Club) with this application and mail to: FTOC, 9378 Rayna Dr., Davison, MI 48423. Membership includes youth under the age of 18 living in the same household.         (Membership Dues are $20.00 per year January-December, prorated)

For more membership information contact: members@FTOC.org or call: 810-653-4976

First Name: __________________________ Last Name: ___________________________________

Spouse:  _____________________________

Address: _____________________________________________

City: _______________________ St: ____ Zip: _____________

Telephone: ___________________________ Email: ______________________________________

Children: _________________________

                 _________________________

                 _________________________

Do you play the organ?   YES   NO      Does a family member?   YES   NO

Do you own an organ?   YES   NO   If yes, what make/type: _________________________________________

Would you be interested in scheduling time to play the Barton 3-11?   YES   NO