Lionbacker Booster Club
Application Form		 Missouri Southern State University
Leggett and Platt Athletic Center

St. John's Track

Robert Ellis Young Gymnasium [Volleyball]

Lion Statue at Hughes Stadium

Hal Bodon Field [Soccer]

Freeman Fitness Center

Midfield at Hughes Stadium

Missouri Southern Cross Country Course

To become a member of the Lionbacker Booster Club please fill out the form below then select the "Send form to Missouri Southern" button.

Registration is NOT complete until check to Missouri Southern Athletics is received OR payment is made by Credit Card.

Please make all checks payable to: Missouri Southern Athletics

Send to:
Missouri Southern Athletics
Attn: Lionbackers
3950 E. Newman Rd.
Joplin, MO 64801-1595

If you wish to pay your membership with a Credit Card (Mastercard, Visa, or Discover) please select this box:
You will be contacted as soon as possible to complete your membership application if you choose to pay with a credit card.

Form fields with an * are required. The form will not submit properly if the information in these fields is not provided.
* Full Name:
Spouse's Name:
* Home Address:
* City/state/zip:
Business Name:
Business Address:
City/state/zip:
* Home Phone:
Business Phone:
* Email:
Name to appear in Programs:
* Membership Level:
Select this box if you wish to make additional $100 gift.
Benefits for Additional $100 Gifts:
Personalized Seats Your name or Business name permanently affixed to your seat in the Leggett & Platt Athletic Center
This additional $100 gift is 100 PERCENT Tax-deductible. Receipts will be mailed indicating the amount of your donation.

Select either Payment In-Full option or Payment Plan option

Payment In-Full options: (Select one option)

*Payment Plan (Select One option): Payments due by March 31to protect seats. Remaining payments due April 30, and May 31. Full payment by May 31 is required to receive tickets.
I want additional basketball season tickets ($125 each)
I want additional football season tickets ($60 each)
I want tickets for family members 17 and under ($25 each)

If you would like any other information, please indicate here:

For additional information contact Aaron Lewis 417.625.9820.
Thank you for completing our online form!

Send an e-mail message 
Missouri Southern State University
3950 E Newman Rd.
Joplin, MO 64801-1595
Updated March 27, 2008 Copyright©; Missouri Southern State University, 2008, all rights reserved.