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Membership Information   Type of Membership: -Select One- Individual - $30 Two Person - $33 Family - $36 Sex: Male Female First Name: Middle Initial: Last Name: Address: City: State: -Select One- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip: Home Telephone: Work Telephone: Social Security Number: Birthdate:     Two-Person / Family Membership Secondary Person's Information Sex: Male Female First Name: Middle Initial: Last Name: Relationship to Primary Member: Spouse Child Social Security Number: Birthdate:     Dependents List all family members eligible for membership. Sex: Male Female First Name: Middle Initial: Last Name: Social Security Number: Birthdate: Sex: Male Female First Name: Middle Initial: Last Name: Social Security Number: Birthdate: Sex: Male Female First Name: Middle Initial: Last Name: Social Security Number: Birthdate:     Payment Method Please choose VISA, Check, or Money Order. VISA   Name As It Appears On Card: Credit Card Number: Expiration Date:     Check or Money Order Make payable to Rex Club, Inc. Do not send cash. A $30 fee will be charged for any non-sufficient fund or returned check. Rex Club, Inc. 24700 W. 12 Mile Road, Suite 101 Southfield, MI 48034