Registration – Trenton Dade Optimist Club

Name *

First

Last Name *

Last

I am

Life Member

Member

On Finance Committee

On Board of Directors

pick all that apply Do not check Life Member and Member boxes

Email Address *

Enter Email

Confirm Email Address *

Confirm Email

Password *

Enter Password

Confirm Password *

Confirm Password

Best Phone # for contacting you

Your birth month

Address

City

State/Province

Zip/Postal

Profile Picture

Maximum file size: 516MB

Please attach a .jpg, .png, .gif or .mpg image. By attaching an image to use as your profile picture you assert that you have rights to use the image and it is not illegal, pornographic or violent in any way.