Internet Seminole Club Membership Form

**** If you experience any problems with the submission of this form, please Email us ****

Please select (click on) your Dues level at the right

Click Here for an Explanation of ISC Annual Dues Levels (12 months)

Please mail dues to:
The ISC
c/o Tom Heisler
5676 Highway 77
Graceville, FL 32440-4010
Make payable to:  "The ISC"

Internet Seminole Club Dues Levels

(Please select one)

Spear $5 individual,          $7 couple
Campbell $7 individual,    $8 couple
Garnet $10 individual,       $15 couple
Gold $25 individual,          $35 couple
Osceola $50 individual,     $70 couple
SPECIAL!! Membership PLUS Brick Participation:
       [add $7 to your dues payment]

Westcott Brick Participation only, $10 (if already a member)

       For more DETAILS on BRICK participation, Click Here


If a GIFT Membership , Please Check Here   

Full NAME of APPLICANT
Nickname (e.g., Liz,Bill,Bob)
Current EMAIL ADDRESS of APPLICANT (REQUIRED!)
Spouse's Full NAME
(if couple membership selected)
Spouse's Nickname (Liz,Bill,Bob)
Spouse's Current EMAIL ADDRESS
Applicant Age Group 0-20 21-30 31-40 41-50
51-60 61-70 71-80 81+
Business Phone
Home Phone
Fax Number
Street Address
City, State, Zip+4
Interests in FSU Football Baseball Basketball Other Sports
Academics Other
Comments or Questions
Reason for Joining
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If a GIFT MEMBERSHIP, Name of Gift GIVER
If a GIFT MEMBERSHIP, Email Address of Gift GIVER
If Gift Membership, Type of Gift

Please NOTE: Submitting this form commits you to joining the FSU-ISC and to sending your dues payment to the address shown above (Tom Heisler, Treasurer).  If you do not intend to join the ISC, please do not press the "submit" button.  Thank you.