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Shomrim
Society of Southern California |
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MEMBERSHIP APPLICATION – Please print this form, fill out completely, sign and mail with your membership dues to the above address.[ ] Full Membership -- $18.00 [ ] Full Membership Renewal -- $25.00 [ ] Associate Membership -- $25.00 [ ] Associate Membership Renewal -- $25.00 Name: (Last, First, MI) _____________________________________ Address: ____________________________________________ City ____________________ State ___ Zip ________-_______ Home Phone ________________ Bus Phone ______________ Email ______________________ DOB ___________________ Employed by ________________________________________ Title or Rank ________________________________________ Business Address _____________________________________ City ____________________ State ___ Zip ________-_______ How did you hear about the Shomrim Society of Southern California? ________________________________________________________
Signature __________________________ Date __________ |