Back
to
Home
Page

Anthony Chamber of Commerce

“Leap Year Capital of the World”

P.O. Box 1086

Anthony, New Mexico/ Texas USA 88021

Tel: (505) 882-5677  Fax: (915) 886-5657 www.leapyearcapital.com
New Membership Application         Renewal  Please note change of Address

Worldwide Leap Year Birthday Club

Applicant must be born on February 29th of any Leap Year to qualify for membership. One application per Leapy.
 
Name: ___________________________________________________ Leap Year of Birth: ______________
 

Address: ______________________________________________________  Address change?    YES    NO
              (Street or Post Office Box)

_______________________________________________________________________________
(City)                                           (State or Province)                                             (Zip or Other Postal Code)                    (Country)
 

(circle size) CHILD:  S    M    L

ADULT:  S   M   L   XL   2XL   3XL

Telephone:  _________________________________________ 

                    (Area/International Code and Number)
 

Place of Birth:_______________________________________________________________________________
                        (City)                                                       (County)                    (State/ Province)                    (Country)

   Enclose $25.00 MEMBERSHIP DUES, renewable every Leap Year before February 1st.

You may pay by Personal Check, Cashiers Check, Money Order or
Credit Card (include number and expiration date).

 
Signature: _________________________________________________ Date:_____________________________
 
Please provide us with the following information. You may use the back of this sheet for your answers.
1. How you learned about the Worldwide Leap Year Birthday Club, and tell us any other information you would like us to know about yourself; 
2. The name and address of your local newspapers;
3. Send the Anthony Chamber copies of any articles, regarding Leap Year, which you might see in newspapers from time to time, include name, date, and page of newspaper.

Add additional personal information on back, if you wish.  Leap Year news articles will be appreciated.
Use the PRINT function on your computer to print this. Fill in the blanks and
mail to address at the top of this application. Include Membership Dues. Thank You!

Back to Home Page