Name:______________________________________________________________

Address:____________________________________________________________

Address:____________________________________________________________

City:________________________________  State:_______  Zip______________

Phone: _________________________  E-mail______________________________________

Skills:______________________________________________________________

Donation: (all contributions include an SCC sticker)

$10 - SCC T-Shirt only (no membership)   Qty: _______	T-Shirt Size: _______
$25 - Belayer Annual Membership (card, no T-shirt)
$35 - Flash Annual Membership (SCC T-shirt and card)	T-Shirt Size:_______
$50 - Lead Dog Annual Membership (SCC T-shirt, plus hat or key chain)	T-Shirt Size:_______
$100 - Hardman Annual Membership (SCC T-shirt, hat and key chain)	T-Shirt Size:_______
$500 - Rock God - Lifetime Membership (Embroidered Fleece Jacket)	Jacket Size:________
$1000 - Lifetime Membership (Embroidered Fleece Jkt, plus t-shirt, hat or key chain)	Jacket Size:________
$5000 - Lifetime Membership (Embroidered Fleece Jkt, plus t-shirt, hat and key chain)	Jacket Size:________
___ Thank you, but keep the swag and spend the money on access.

Any questions? info@seclimbers.org
 
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