____  $750 Captain        ____  $500 First Mate        ____  $250 Navigator

                  ____  $100 Cook            ____  $ 50 Deckhand          ____  $ 25 Cabin

Name:_______________________________________________________________________________  

                                                           
Address:_____________________________________________________________________________


Home Phone:(____) ________________ Business Phone: (____) _____________________________

I would like to designate my gift for:    
Athletics (General)________________ Specific Program (Team)______________________________

Check Enclosed: Please make checks payable to : MJC College Foundation - Athletic Fund $___________

Charge To My Credit Card: (Visa or Master Card Only) $_______________ Exp. Date ___________________

Card Number: ______________ - __________________ - _____________ - _____________________

Signature:____________________________________________________________________________

Please print and complete the Pirates Booster Club Membership Form and mail to : MJC College Foundation  - Athletic Fund, 435 College Avenue,  Modesto, CA 95350

THANK YOU FOR YOUR CONTRIBUTION!