JOHNNY DEROSE FAN CLUB
TRIBUTE TO ELVIS
APPLICATION FOR MEMBERSHIP
Name:______________________________________________
Address_____________________________________________
Phone:__________________________________
Age:______________(Optional)Birthday:____________________
Send Check or Money Order to:
Shirley Schwebs
2620 Virginia Drive
Kissimmee, FL 34741
Phone: (407)847-3012
DUES: $10.00 per year.
Club Membership entitles you to: Quarterly Newsletters, Membership Card, Special Bulletins, Special Social Functions,
8x10 color photo, Special item for renewal.
What things would you like to see in the newsletter:_____________________________________________________
How did you hear about Johnny and where have you seen him perform?_____________________________________________________________________
We thank you for your interest in Johnny and we hope to make your association with this club a rewarding experience.
We welcome your comments and suggestions.
Vice-President: Diane Barrett
Secretary: Brenda Deems
Coordinator: Alberta Hiller
Treasurer: Brenda Deems
Publicity: Linda Hiller
