Fillable Community Impact Bundle Activation (Optimist International)

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Community Impact Bundle Activation (Optimist International)

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ACTIVATION FORM
Optimist Clubs must use this form to activate the individual Friend Memberships
that are included in the Community Impact Bundle. One form is required for each of the
six Members included in the bundle.
Community Impact Bundle Activation Form 2015-16
Is this activation a gift? Yes No
Club Name: Club Number:
Name of Friend to be activated:
Address:
City: State/Province: Zip/Postal Code:
Home Phone: Email:
(BILLING ADDRESS IF DIFFERENT)
Address:
City: State/Province: Zip/Postal Code:
Sponsored by an Optimist Club (if applicable): Member:
Return to: Optimist International ∙ 4494 Lindell Blvd. ∙ St. Louis, MO 63108 ∙ FAX: 314-371-6006 ∙ bakerc@optimist.org
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Community Impact Bundle Activation (Optimist International)

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Completed 23 July 2020

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