MEMBERSHIP APPLICATION

(please print)

                                                                               

NAME ______________________________________________________________________________________________

 

Date joined _____________________________________________

SPOUSES NAME (if family membership) _________________________________________________________________

 

 

OTHER FAMILY NAMES (if applicable) ___________________________________________________________________

 

 

ADDRESS ___________________________________________________________________________________________

 

 

CITY __________________________________________ STATE ___________ ZIP CODE __________________________

 

 

PHONE _____________________________________ EMAIL __________________________________________________

 

 

ANNUAL DUES TYPE (check one)                                                       Referred by ______________________________

 

                         REGULAR $22.00                              FAMILY $27.00                       

 

 

The clubs fiscal year runs from January 1st To December 31st

 

Make checks payable to: "Sansui Kai of Southern California"

 

Print completed form and send with your check for membership to:

Sansui Kai Membership

attn: Steve Riley

26024 Manzano Court

Santa Clarita CA 91355

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