CANYON CROSSWINDS
P.O. BOX 55694 VALENCIA CA. 91385-0694
JUNE 1, 2005 - MAY 31, 2006
MEMBERSHIP APPLICATION
| MEMBERSHIP CATEGORIES: | ANNUAL DUES: | |
| [1] SENIOR: | 65 Years of age or older: | $45.00 |
| [2] FAMILY: | Husband, wife & children under 18 yrs: | $60.00 |
| [3] JUNIOR: | 18 years or younger w/o participating adult: | $45.00 |
| [4] ADULT: | 18 years or older: | $60.00 |
NEW MEMBERS FIRST YEAR'S DUES PAYABLE AS FOLLOWS:
| FAMILY-ADULT: | SENIOR: | JUNIOR: | |
| [1] FIELD ASSESSMENT | $75.00 | $75.00 | $0.00 |
| [2] ANNUAL DUES: | $60.00 | $45.00 | $45.00 |
| [3] KEY DEPOSIT: | $5.00 | $5.00 | $5.00 |
| TOTAL: | $140.00 | $120.00 | $50.00 |
*50% after 1/2 of current year
|
ALL MEMBERS MUST DISPLAY
A CURRENT A.M.A. AND |
MEMBERSHIP PROFILE
RENEWAL: _____________________ NEW MEMBER: ______________________
NAME: ____________________________AMA # ____________________________
ADDRESS: ____________________________________________________________
CITY: _____________________ ZIP: ______________ BIRTHDAY: _____________
HOME TELEPHONE: (____)_______________ CELL: ________________________
E-MAIL ADDRESS: _________________OCCUPATION: _____________________
IF FAMILY APPLICATION, LIST OTHER PARTICIPATION MEMBERS
NAME: ___________________________ AMA # ____________________________
NAME: ___________________________ AMA # ____________________________
Check attached in the amount of $ ____________
SIGNATURE: ___________________________ DATE: ______________________