24 / 63
2016-2017 PIPER MEMBERSHIP
REGISTRATION FORM
PIPER NAME: ____________________________________________________________________
As you wish for it to appear in the program
EMAIL:
____________________________________________________________________
Please circle one:
Family - $250.00
Individual - $150.00
100% of your membership contribution to the Foundation helps children in need.
Please make a copy of this form as your receipt for tax purposes.
Please make your check payable to:
Bobby Nichols-Fiddlesticks Charity Foundation or BNFCF
Mail or drop off
your application and check to:
Bobby Nichols-Fiddlesticks Charity Foundation
c/o Fiddlesticks Country Club
15391 Canongate Drive
Fort Myers, FL 33912
THE BOBBY NICHOLS-FIDDLESTICKS CHARITY FOUNDATION IS A 501C3 TAX EXEMPT ORGANIZATION. CERTIFICATE #85-8012782366C-
0. A COPY OF THE OFFICIAL REGISTRATION AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER
SERVICES BY CALLING TOLL-FREE (800-435-7352) WITHIN THE STATE. REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL,
OR RECOMMENDATION BY THE STATE.