Name:________________________________ Spouse:______________________

Co-Member (If applicable):_____________________________________________

Address:_________________________________ City:__________ Zip:_________

Telephone: (Day)_________________ (Evening)____________ (Cell)___________

E-Mail Address:__________________________ Fax:________________________

I am willing to receive the Newsletter via E-Mail: _____ Yes _____ No

Type of Membership: ___________ Individual/Active $30.00 

                          ___________Renewal ___________New Member

I am interested in the following committees:

_____ Communications                                           _____ Hospitality

_____ Membership                                                    _____ Publicity

_____ Special Projects                                              _____ Newsletter

_____ Fund Raising                                                   _____ Programs

_____ Education                                                         _____ Volunteer Coordinator

 _____ Grants

Please make your check payable to:    BRIGHTER TOMORROWS, INC. 

                                             RETURN CHECK AND COMPLETED MEMBERSHIP FORM TO:

 Brighter Tomorrows, Inc.

ATTN: MEMBERSHIP CHAIRMAN

3111 West Dr. MLK, Jr. Blvd., Suite 100, Tampa, FL 33607