BNFCF Board Meeting November 14 2016

2016-2017 PIPER MEMBERSHIP REGISTRATION FORM

PIPER NAME: ____________________________________________________________________ As you wish for it to appear in the program

EMAIL:

____________________________________________________________________

Please circle one:

Family - $250.00

Individual - $150.00

100% of your membership contribution to the Foundation helps children in need. Please make a copy of this form as your receipt for tax purposes.

Please make your check payable to: Bobby Nichols-Fiddlesticks Charity Foundation or BNFCF

Mail or drop off your application and check to: Bobby Nichols-Fiddlesticks Charity Foundation c/o Fiddlesticks Country Club

15391 Canongate Drive Fort Myers, FL 33912

THE BOBBY NICHOLS-FIDDLESTICKS CHARITY FOUNDATION IS A 501C3 TAX EXEMPT ORGANIZATION. CERTIFICATE #85-8012782366C- 0. A COPY OF THE OFFICIAL REGISTRATION AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES BY CALLING TOLL-FREE (800-435-7352) WITHIN THE STATE. REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL, OR RECOMMENDATION BY THE STATE.