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
20561 Martingale Place
Santa Clarita CA 91350