Varsity Club

For more information, please call the Beach Athletic Fund at (562) 985-4550.

First Name: *

Middle Initial:

Last Name: *

Maiden Name:

Spouse Name:

Gender: *

Male Female

Mailing Address: *

City: *

State: *

ZIP: *

Preferred E-mail: *

Phone: *

Cell Phone:

Fax:

I participated in SPORT(S): *

I participated in this sport starting in: *

I finished participating in this sport in: *

Employer and Job Title:

Date of Birth (MM/DD/YYYY):

I am interested in becoming a GOLD member: Yes No

Yes, make my information available exclusively to all BAF Varsity Club members: Yes No

Contact Kori Kaufman with any questions - she would be happy to answer them:
562.985.4550 (d) 714.702.4660 (c) kori.kaufman@csulb.edu

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