SEND US THE FOLLOWING INFO AND $20 PER PERSON , $40 PER FAMILY OF TWO OR MORE

NAME_____________________________________________________

SPOUSE/FRIEND__________________________________________

STREET ADDRESS_________________________________________

CITY_____________________________STATE______ZIP__________

HOME PHONE_____________________________________________

WORK PHONE_____________________________________________

CELL PHONE______________________________________________

EMAIL ADDRESS___________________________________________

BIRTHDATE  (year optional)_________________________________

SPOUSE/FRIEND BIRTHDATE_______________________________

KIDS NAMES AND AGES____________________________________

____________________________________________________________

Email or Snailmail to either:

Steve Torres, President, 2227 Willowpark Court, Thousand Oaks

91360; mnsgravevine@hotmail.com  or

George Graham, Treasurer, 5215 Evanwood Ave., Oak Park, 91377;

Georgeg536@lcph.org