Membership Form

Annual Membership Application

Please be sure to indicate the level of membership you will be paying for. Options are:

Platinum Life Angel ($250.00) - name included in the membership book, a Boley Angels name badge, and one-time admission for two (2) to Boley Centers’ Jingle Bell Run VIP event for the year the Platinum Angel level is paid for. This is a night-time event that takes place on a Friday night in early December and includes a parking pass, food, drink, and a bird’s eye view of the run. Event admission is transferable. This level has no annual dues.
Gold Angel ($100.00) - name included in the membership book and a Boley Angels name badge.
Bronze Angel ($50.00) – name included in the membership book and a Boley Angels name badge.
Angel ($25.00) - name included in the membership book and a Boley Angels name badge.

Membership Level Options

Amount

Please print your name as you would like it to appear on your Boley Angels Membership Badge: If you do not need or want a badge, please write "none."

Contact Information

First Name

Last Name

Company Name

Address

Address 2

City

State/Province

Zip/Postal Code

Home Phone

Cell Phone

Work Phone

Payment Information

Payment Options

Credit Card Information

Card Holder Name

Card Account Number

Expiration Date

Security Code

Billing Address

Same As Above

Address

City

State/Province

Zip/Postal Code

A COPY OF THE OFFICIAL REGISTRATION AND FINANCIAL INFORMATION MAY BEOBTAINED FROM THE DIVISION OF CONSUMER SERVICES BY CALLING TOLL-FREE (800-435-7352) WITHIN THE STATE. REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL, OR RECOMMENDATION BY THE STATE." REGISTRATION #CH310.