Name ___________________________________________________

Spouse Name ____________________________________________

Address _________________________________________________

City ______________________ State _________ Zip ____________

Home Phone _____________________________________________

Daytime Phone____________________________________________

Self-Employed ____________________________________________

Employer ________________________________________________

Check One: Alumnus ____ Letterman ____ Friend ____

Signature__________________________ Date __________________

Method of Payment:
By Check______
VISA....................... No._________________________ Exp Date__________
Mastercard.............. No._________________________ Exp Date__________
Check here ________ if you want further information as to pledge, installment or bank draft.

Mail Payment (payable to Bulldog Club, Inc.) and Application To:
The Bulldog Club, Inc.
P. O. Drawer BT
Mississippi State, MS. 39762

Please select membership preference below:

______ Endowed Scholarship ($50,000 or more)

______ Intercollegiate Champion ($25,000 - $49,999)

______ Top Dog Division ($10,000 - $24,999)

______ VIP Division ($5,000 - $9,999)

______ Silver Division ($2,500 - $4,999)

______ Superdog Division ($1,000 - $2,499)

______ Maroon Division ($500 - $999)

______ White Division ($250- $499)

______ Century Division ($100 - $249)

______ Mad Dawg Division (Ages 1-25, $50 - $99)

For further information, please contact the Bulldog Club at 601-325-3074.