BIXBY QUARTERBACK CLUB
BIXBY QUARTERBACK CLUB 2012 MEMBERSHIP APPLICATION The Bixby Quarterback Club is a Not for Profit Oklahoma Corporation. Membership fees are tax deductable with the exception of the value of the merchandise received with each Membership.
Membership Levels :(Please Circle Level)
Membership Includes:
$25 JR Spartan Membership **Only K – 7th Grade eligible**
Recognition in Program JR Spartan T-Shirt only JR Spartans will have! Form Line at Tunnel during 1 home game
$50 Bronze Spartan
Recognition in Program Window Decal Bixby Football Yard Sign Two QBC logo t-shirts
$100 Silver Spartan
Recognition in Program Window Decal Bixby Football Yard Sign Two Polo Style QBC shirts One reserve parking pass Recognition in Program Window Decal Bixby Football Yard Sign Two Polo Style QBC Shirts One reserve parking pass Bixby Spartan stadium Blanket Recognition in Program Window Decal Bixby Football Yard Sign Two Polo Style QBC Shirts One reserve parking Pass Bixby Spartan Stadium Blanket Two Tickets to the Bixby vs. Jenks Game
$200 Gold Spartan
$500 Platinum Spartan
Name: ______________________________________________________Spouse: _________________________________________________ Bixby Alum: Y/N (Name as you wish it to appear in the football program) PLAYER BEING SPONSORED FOR SCHOLARSHIP: ________________________________________________________2012/13 GRADE: ___________________ Address: _______________________________________________________________City: __________________State: __________ Zip:_____________ Phone: Home____________________________ Cell#1 _____________________________ Cell #2 _____________________Work ____________________________ E-Mail Address: _______________________________________________________________________________________________ (We use E-Mail to send out notifications, receipts and updates, please keep this updated) Silver – Diamond Members: Shirt Sizes: Men: Med - XXLG ______________ Ladies: Sm - XLG________________ If you would like all of your proceeds to benefit the Quarter Club, then you can request no promotional item(s). If you DO NOT wish to receive any promotional items, please initial this line. ________________ Please make checks payable to “BIXBY QUARTERBACK CLUB” P.O. BOX 434, BIXBY, OK 74008 Payment by Credit Card: VISA/MC ONLY : (Receipt will be emailed to you when charge is made) Card #: ________________________________________ 3 digit CVS # ___________ Expiration Date: ____________ Name on Card: ___________________________________________ Billing Zip Code ______________ Billing Address: ______________________________________________City: ___________________State: __________ Signature: ________________________________________________________
For more information contact: Keith Kirk, President, 918-630-2277; [email protected] or [email protected] QBC use only: Date rec’d: _________________ Cash______________ Ck #: _________________ Credit Card: ____________
Membership Levels :(Please Circle Level)
Membership Includes:
$25 JR Spartan Membership **Only K – 7th Grade eligible**
Recognition in Program JR Spartan T-Shirt only JR Spartans will have! Form Line at Tunnel during 1 home game
$50 Bronze Spartan
Recognition in Program Window Decal Bixby Football Yard Sign Two QBC logo t-shirts
$100 Silver Spartan
Recognition in Program Window Decal Bixby Football Yard Sign Two Polo Style QBC shirts One reserve parking pass Recognition in Program Window Decal Bixby Football Yard Sign Two Polo Style QBC Shirts One reserve parking pass Bixby Spartan stadium Blanket Recognition in Program Window Decal Bixby Football Yard Sign Two Polo Style QBC Shirts One reserve parking Pass Bixby Spartan Stadium Blanket Two Tickets to the Bixby vs. Jenks Game
$200 Gold Spartan
$500 Platinum Spartan
Name: ______________________________________________________Spouse: _________________________________________________ Bixby Alum: Y/N (Name as you wish it to appear in the football program) PLAYER BEING SPONSORED FOR SCHOLARSHIP: ________________________________________________________2012/13 GRADE: ___________________ Address: _______________________________________________________________City: __________________State: __________ Zip:_____________ Phone: Home____________________________ Cell#1 _____________________________ Cell #2 _____________________Work ____________________________ E-Mail Address: _______________________________________________________________________________________________ (We use E-Mail to send out notifications, receipts and updates, please keep this updated) Silver – Diamond Members: Shirt Sizes: Men: Med - XXLG ______________ Ladies: Sm - XLG________________ If you would like all of your proceeds to benefit the Quarter Club, then you can request no promotional item(s). If you DO NOT wish to receive any promotional items, please initial this line. ________________ Please make checks payable to “BIXBY QUARTERBACK CLUB” P.O. BOX 434, BIXBY, OK 74008 Payment by Credit Card: VISA/MC ONLY : (Receipt will be emailed to you when charge is made) Card #: ________________________________________ 3 digit CVS # ___________ Expiration Date: ____________ Name on Card: ___________________________________________ Billing Zip Code ______________ Billing Address: ______________________________________________City: ___________________State: __________ Signature: ________________________________________________________
For more information contact: Keith Kirk, President, 918-630-2277; [email protected] or [email protected] QBC use only: Date rec’d: _________________ Cash______________ Ck #: _________________ Credit Card: ____________
