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:

Sandy Thompson,  Club President,

420 San Nicolas, Santa Paula, CA, 93060,

Email: nannie_4@verizon.net

  or

George Graham, Treasurer,

368 Via De La Mesa, Newbury Park, CA 91320 ;

Email: Georgeg536@lcph.org