GROUPON MEMBER APPLICATION FOR JENKINS ARBORETUM MEMBERSHIP

PRIMARY MEMBER:

First Name:________________________________ Last Name:_________________________________

Address:___________________________________ City, State:___________________ Zip:___________

Home Phone:______________________________ Cell Phone:___________________________________

Email Address:______________________________________

GROUPON VOUCHER NUMBER:_________________________

groupon SPECIAL MEMBERSHIP PRICE: ______ $22

membership is valid for up to two adults and four children or three adults and three children. Please provide addition member names:

1. ____________________________________________
2. ____________________________________________
3. ____________________________________________
4. ____________________________________________
5. ____________________________________________

ADMINISTRATIVE USE ONLY:

CK#:________ Packet Received:________ Date of Sale:_________ Trans #: _________ Initials:_________