Membership
Application
7304
NE 175th Street
PO Box 82171
Kenmore, WA 98028
Names
(Husband, Wife)______________________________________Phone________________
Address
_______________________________________________________________________
City, State, Zip
________________________________________________________________
E-mail
______________________________________________________________________
Birthdays (month and day only) Husband ____________ Wife ____________
Dues for January through December ____________ (year) $10 per person
per year
Mail to above address.
Would you like to be called by phone to be reminded of the
potluck/meeting? Yes(__) No (__)
Today's date ____________________
THANK YOU
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