Greater Dallas Pachyderm Club
Membership Form
I hereby apply for membership in the Grand Order of Pachyderms. I understand that my yearly dues of $42 includes membership in the National Order of Pachyderm Clubs, the Texas Federation of Pachyderm Clubs, and the Greater Dallas Pachyderm Club.

(Please Print Legibly)

Name:________________________________________________________________

Address:______________________________________________________________

City, State, Zip:_________________________________________________________

Home Phone__________ Phone(s) you want listed with us:______________________

Fax:____________ e-mail address:_________________________________________

Referred by:___________________________________________________________

            Check for $42.00 enclosed

            Charge my credit card
                Name on card:________________________________________________
                Card number:_________________________________________________
                Expiration date:_______________________________________________
                Signature:___________________________________________________

Please mail this form with $42 annual dues to:
Bob Schies
Treasurer, Greater Dallas Pachyderm Club
3523 Brookhaven Club Drive
Farmers Branch, TX 75234