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| Yearly
membership dues, renewed each December: Family $20, Individual $15 |
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| Name: |
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| Additional
Member(s): |
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| Additional
Member(s): |
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| Address: |
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| City: |
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| State: |
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| Zip: |
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| Phone/Fax: |
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Birthday |
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Anniverary
Date: |
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| E-mail: |
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| The cost of the plastic LACSS name badge is $8.00 |
| Send this form with check or money order to: | |
| LACSS Membership Chair | |
| P.O. Box 280581 | |
| Northridge, CA 91328 | |
| For more info call 818/970-0405 |
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