DEFENDER GOLD CLUB

2015-16 Membership Form

Membership Information

Full Name:
*
Spouse’s Name:
Primary Phone:
*
Email:
*
Address Line 1:
*
Address Line 2:
City:
*
State/Province:
*
Zip/Postal Code:
*

Membership Levels and Premiums

Check membership level and corresponding premium box as well as appropriate sizing for the item you have selected. Additional apparel can be purchased at football, volleyball, and basketball games or by contacting Derek Keizer, as listed at the bottom of this page.

By checking this box I am declining my membership premium and will receive a receipt for my full membership amount

Level and Premium ($ value)

WHITE level ($50)
  • Game Programming Listing
  • Website Recognition
BLACK level ($250)¹
  • Men: Under Armour ETA Tech 1/4 Zip ($30)
  • Women: Under Armour Twisted Tech 1/4 Zip ($33)
  • Men: Under Armour Ultimate Team Jacket - $30 extra ($60)
  • Women: Under Armour Wrap Up Full Zip - $22 extra ($55)
SILVER level ($500)¹
  • Men: Under Armour ETA Tech 1/4 Zip ($30)
  • Women: Under Armour Twisted Tech 1/4 Zip ($33)
  • Men: Under Armour Ultimate Team Jacket - $30 extra ($60)
  • Women: Under Armour Wrap Up Full Zip - $22 extra ($55)
  • 1 DGC Athletic Banquet Ticket
GOLD level ($1,000)¹
  • Men: Under Armour Ultimate Team Jacket ($60)
  • Women: Under Armour Wrap Up Full Zip ($55)
  • 2 DGC Athletic Banquet Tickets
PLATINUM level ($2,500)¹
  • Men: Under Armour Ultimate Team Jacket ($60)
  • Women: Under Armour Wrap Up Full Zip ($55)
  • 2 DGC Athletic Banquet Tickets
  • All Sports Family Season Pass
DIAMOND level ($5,000)¹
  • Men: Under Armour Ultimate Team Jacket ($60)
  • Women: Under Armour Wrap Up Full Zip ($55)
  • 2 DGC Athletic Banquet Tickets
  • All Sports Family Season Pass
  • Dordt Basketball Reserved Parking Pass

Premium Options

Men’s size selection:
S M L XL XXL XXXL
Women’s size selection:
S M L XL XXL
Delivery method:
Pick up Mail
(We will call/email when item is available for pick up)

¹ For BLACK Level and above you may designate your gift toward a specific sport:

Payment Information

Amount to be charged:
Credit Cards
Card Type:
*
Card Number:
*
CVV/CVC:
*
Expiration Date:
*
Comments:

Contact Information

Glenn Bouma, Defender Gold Club President, 712-722-6305, Glenn.Bouma@dordt.edu

Derek Keizer, Defender Gold Club Board Member, 712-722-6369, Derek.Keizer@dordt.edu

For a printable form and to pay by cash/check, please contact Glenn Bouma or Derek Keizer.