Please PRINT Clearly:
Date: |
___________________________ |
| Name(s): |
_________________________________ |
|
_________________________________ |
| Children: |
_________________________________ |
| Address: |
_________________________________ |
| City, ST, ZIP: |
_________________________________ |
| Home Phone: |
(_____)__________________________ |
| Work Phone: |
(_____)__________________________ |
| e-mail: |
_________________________________ |
| Occupation: |
________________/________________ |
Original Hometown |
________________/________________ |
| HS or College |
________________/________________ |
Favorite Browns Player |
________________/________________ |
 |
Current Retired |