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Admirals 5 Star Kids Club
Membership Application

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All fields marked with an * are required.

 

*Kids Name:
* First Name:
* Last Name:
* Mailing Address:
* City:
* State:
* Zip Code:
* Day Phone:
* Evening Phone:
* Email Address:
Please contact me by:
Phone  Email
Birthday:
School:

(Please be sure your contact information is filled out completely and correctly above)

Cost for the Admirals 5 Star Kids Club is $20 for each child.

 

Payment Information

Use above information for Billing
Payment Options: 
* Card Holder First Name:
* Card Holder Last Name:
* Billing Address:
* Billing City:
* Billing State:
* Billing Zip:
* Card Number:
(Please enter credit card number without the spaces.
ex. 1122334455667788)
* Expiration Date:

* Amount to charge
to credit card:
$20
 

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Norfolk Admirals Hockey, Inc.    201 East Brambleton Ave.   Norfolk, VA 23510   757.640.1212
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