Old Bats & Red Hats
Name: ________________________________________________________________________
Address: ______________________________________________________________________
City, State and Zip Code: _________________________________________________________
Phone #: ______________________________________________________________________
Email Address: ________________________________________________________________
Age: ______ Birthdate: ___________ Profession: _____________________________________
Marital Status: Single: ____ Married:___ Divorced: ___Widowed: ____ Other: _____________
Children and/or Grandchildren: ____________________________________________________
Pets: _________________________________________________________________________
Previous Profession: _____________________________________________________________
Previous Place of Residence (city/state): _____________________________________________
Personal Interests (please be specific so it is of more value when matching with other members):
Cards (bridge/gin/etc.): ____________ Movies: (comedy/horror/scifi/etc.)__________________
Plays: ___________ Music: ___________________________ Restaurants: _________________
Sports Events: _______________ Books: ____________________________________________
Knitting/Sewing: ____ Bowling: _____ Health Club/Exercise: ___________________________
Other Interests and Hobbies: ______________________________________________________
Favorite Travel Location(s):_______________________________________________________
Do you want to get separate mailings and be part of the book club? _______________________
Would like to do the following activity(ies) with other Old Bats and Red Hats members: ______________________________________________________________________________
Questions/Comments: ___________________________________________________________
_____________________________________________________________________________