Please print out or download the PDF version

Name: _____________________________

Address: __________________________


Phone Numbers: ____________________

Office: ___________________________

Home: _____________________________


Club Lounge Membership Level:
 *please circle one*

VIP Seating: $1252/person
(Portion of proceeds go to support the Georgia Tech
Letterwinner's Club Hall of Fame Induction Banquet)

Lounge Membership: $250 per person with annual $50 membership dues.


Please make checks payable to the Alexander-Tharpe Fund
or charge to your Visa, Mastercard, or American Express

Card # : ________________________________

Exp. date: ______________________________


Alexander-Tharpe Fund
150 Bobby Dodd Way
Atlanta, GA 30332-0455
404-894-5414