Jacket Backers Membership Application

Jacket Backers Membership Application
The OFFICIAL Fan Club of your Columbus Blue Jackets!
Please fill out the form below, then follow the directions at the bottom.

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Membership Application
Membership Type:	Individual Joint

First Name:
MI:
Last Name:
Address1:
Address2:
City:
State/Province:
Postal/ZIP Code:
Country:
Email:
Birthday:	Enter as: mm/dd/yyyy (You must be at least 21 years old to join.)
Phone:	Digits only, please, starting with your area code. (eg. 6145551212)

I would prefer to receive my newsletter: E-Mail Mail Neither (Newsletters will be made available for viewing online.)

Are you a PSL Holder: Yes No

Please select your method of Payment of Membership dues:

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