Nova Belgica Membership Entry Form

Upon joining Nova Belgica, you will become elligable for discounts on all Nova Belgica activities.

1. To join Nova Belgica please complete the form below and submit it via email. (optional)
2. Printed copy of this form and enclose a check to the order of Nova Belgica
3. Mail the form and your check to: Nova Belgica B.O.I.R.E. , 2009 Lubbock Street, Houston, TX 77007

Membership Fees 2009
Family Membership
$40.00
Single Member
$30.00
First Name
Last Name
Company
Spouse's First Name
Spouse's Last Name
Children's Name(s) Year of Birth (YYYY)
   
   
   
Address
 
City State Zip Code
Home Phone Home Fax
Email Address Mobile Phone
Email Address Confirmation  
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Thank you for becoming a member of Nova Belgica. We look forward to seeing you at the next activity.