GRANDPARENTS' CLUB

Name_____________________________________________________________

Address___________________________________________________________

City_________________________ State______________ Zip______________

Phone number___________________ Cell number___________________

Level of Membership: GOLD_______ SILVER_______ BRONZE_______

Please indicate your shirt size: S_____ M_____ L_____ XL_____ XXL_____

_____Please send me a coupon book for 12 monthly installments.

Thank you for your support of PPCS. Welcome to Grandparents' Club!!