DEFENDER GOLD CLUB

Membership Form

Membership Information

Name:
*
Spouse’s Name:
Primary Phone:
*
Email:
*
Address Line 1:
*
Address Line 2:
City:
*
State/Province:
*
Zip/Postal Code:
*

Membership Levels and Premiums

Check membership level and corresponding premium box as well as appropriate sizing for the item you have selected. If you would like additional items or to upgrade your item for an additional cost, please contact Chad Hanson below.

By checking this box I am declining my membership premium and will receive a receipt for my full membership amount

Level and Premium ($ value)

MEMBER level ($50) DGC acrylic decal ($3)
CLUB level ($100) DGC gold dry-zone S/S t-shirt available sizes in adult or ladies cut ($17) DGC silver dry-zone S/S t-shirt available sizes in adult or ladies cut ($17)
DEFENDER level ($250)¹ DGC steel gray L/S dri-mesh t-shirt ($20)
BRONZE level ($500)¹ ² DGC ladies black full-zip sport-wick jacket ($41) DGC black with gray half-zip sport-wick pullover ($38)
SILVER level ($1,000)¹ ² DGC black soft-shell jacket available sizes in adult, and ladies ($40) DGC black soft-shell jacket available sizes in adult tall ($40)
GOLD level ($5,000)¹ ² DGC Nike men’s white L/S polo ($50) DGC Nike men’s white L/S polo tall ($50) DGC Nike women’s black L/S polo ($50)

Premium Options

Men’s size selection:
S M L XL XXL XXXL Large Tall XL Tall XXL Tall
Women’s size selection:
S M L XL XXL
Delivery method:
Pick up Mail
(We will call/email when item is available for pick up)

¹ For DEFENDER Level and above you may designate your gift toward a specific sport:

² BRONZE level and above will receive a complimentary ticket to the Defender Gold Club Athletics Banquet on April 24, 2015.

Payment Information

Amount to be charged:
Credit Cards
Card Type:
*
Card Number:
*
CVV/CVC:
*
Expiration Date:
*
Comments:

Contact Information

Glenn Bouma, Defender Gold Club President, 712-722-6305, Glenn.Bouma@dordt.edu

Chad Hanson, Defender Gold Club Board Member, 712-722-6320, Chad.Hanson@dordt.edu

For a printable form and to pay by cash/check, please contact Glenn Bouma or Chad Hanson.