MEMBER INFORMATION
* PRINCIPAL MEMBER NAME:		ASSOCIATE'S NAME:
Please list dependents: unmarried dependent under 21, residing at home or away at school.
DEPENDENT'S NAME:		BIRTHDATE:
DEPENDENT'S NAME:		BIRTHDATE:
DEPENDENT'S NAME:		BIRTHDATE:
* ADDRESS:		* CITY:
STATE:	California	* ZIP:
* DAY PHONE:		* EMAIL:
DUES
Principal Member $50 Associate Member $25 Dependent Member(s) $25
NOTE: There is a one-time enrollment fee of $15 for Principal Membership only.
PRINCIPAL MEMBER:		$ $65.00 ($50 plus $15 enroll fee)
ADDITIONAL MEMBER(S):		QTY: @ $25 ea.
* TOTAL:		$