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Cauliflower Alley Club
Membership Application / Renewal

Fill out this form, then print it on your printer.
Basic dues $25 world wide* ($35 in Canada/Mexico or $45 in other Overseas locations IF member wants to receive MONTHLY, 12-page newsletters) *Includes only SEMI-ANNUAL newsletters for non-U.S. residents

Name
 Professional Name
Street Address
 City
State
 Zip Code
Country/Postal Code
 Telephone
E-Mail Address
 Birth Date
Please check all that apply:
Wrestler Boxer Amateur Professional Active Retired
Anyone can join the club.   You do not have to be involved in a ring related profession, but let us know what you do, and send a photo and short biography for our records.   Please list any titles, weight divisions, countries, dates, etc. on a separate sheet or the back of this form.   We welcome photos, clippings, etc.

Enclose your check or money order for the dues donation, the amount depending upon whether you live in the U.S., Canada/Mexico, or Elsewhere, plus any additional (tax deductible) donation, and mail to:

Cauliflower Alley Club, HCR 33, Box 107, Rolla MO 65401
--PHONE (573) 729-2775, FAX (573) 729-7998

Upon receipt of dues, your new Membership Card and parchment Membership Certificate will be mailed.