Membership Application 2021-2022

FOR MEMBERSHIP QUESTIONS

CONTACT

Carole Ann Wall

Vice President - Membership & Programs

caroleannhb@yahoo.com

________________________________________________________________________________________________________________

Today's Date * +

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

This is my *

Home	Business
Cell

Alternate Phone:

This is my

Home	Business
Cell

Email Address

Spouse / Significant Other / Emergency Contact

Relationship

Spouse / SO / Emergency Phone Number

Applicant's Birthday *

Area of Interest

Membership Fee: $36.00 -- Will Pay By: *

Check

Cash

Applicant's Signature *

clear

If completing this form manually, please make check payable to:

Sand Dollars of Huntington Beach

and postal mail application to:

Sand Dollars of Huntington Beach

Attention: Membership

P. O. Box 7349

Huntington Beach, CA 92615