July 1 through June 30
Last Name_________________________ Date
of Application___________________
Adults: First Name Date of Birth Occupation
______________ ______________
____________________________
______________ ______________
____________________________
Children (under 23 years)
______________ ______________
________________
______________ ______________
________________
Address:
Street__________________________________________________________________________
City________________________________State______ZIP_____________
+ ______
Home Phone #: (____)_________________
Cell Phone #: (____)__________________
E-Mail:________________________________________________________
(Print Carefully)
CIRCLE --- Category and amount enclosed:
Associate
Family Single (Newsletter Only)
Renewal July 1 to Oct 1 $55 $45 $20
Renewal after Oct 1 $65 $55 $20
Circle which committee you would like to
work on this season:
1. Newsletter 5. Programs 8. Membership
11. Council Rep
2. Adult Racing 6. Activities 9.
Nominating 12. Other
_________________________
3. Junior Racing 7. Travel 10. Meeting
Host at Your House (which month?)
___________
4. Chalet
Make your check payable to "San Diego
Ski Club", and send to:
Amelia Putnam Phone: (858) 882-7273
4141 Alabama St. # 3 E-Mail:
ameliaputnam@gmail.com
San Diego, CA 92104
LIABILITY WAIVER MUST BE
SIGNED and attached to renewal
Date Received _________ Amount Received
___________
_____________________________________________
A(NC-57A):\Membership Renewal Form
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