*Make checks payable to the Binghamton University or pay with
MasterCard     Visa     AMEX    
Account #
Exp. Date
Membership year

CHILD #1
Name
Address
City     State     Zip
Home Phone (include area code)
Birthdate     E-mail
Age     Grade     Gender: Male / Female
Parent(s) Name
T-shirt size (check one)
Ysmall     Ymedium     Ylarge     Asmall     Amedium

CHILD #2
Name
Address
City     State     Zip
Home Phone (include area code)
Birthdate     E-mail
Age     Grade     Gender: Male / Female
Parent(s) Name
T-shirt size (check one)
Ysmall     Ymedium     Ylarge     Asmall     Amedium

MAIL TO:
Binghamton University – Events Center
c/o Junior Bearcat Club
P.O. Box 6000
Binghamton, NY 13902