LOS CALIFORNIANOS

APPLICATION FOR REGULAR OR JUNIOR MEMBERSHIP

Please type or print your name as you wish it to appear:

( Mr./Mrs./Ms./ Miss/ Dr.) ________________________________________________________
Circle one                                                                     First Name, Middle Name, Last Name

Occupation: _______________________________ Birth date: __________________________

Address: ______________________________________________________________________

_______________________________________________________________________________
City                                                                                                                                         State            Zip (nine digits if known)

Phone:  _______________________   E-mail: _______________________________________ 

I have read the Membership Information and apply as follows:
1. ____ as a descendant* for ____ Regular or ____ Junior Membership or

2. ____ as a spouse of ________________________________________#__________ or
                                               Name of Regular Member and Member's Number
3. ____ (subject to approval of the Board of Directors) as  a ___ spouse ___ widow

    ____ widower of ___________________________________________#____________
                                      Name of past Regular Member and Member's Number

Signature: __________________________________________ Date: ______________

I learned of Los Californianos from ______________________________________________

I was persuaded to apply by _______________________________________(whom/what?)

Each application MUST be accompanied by a check payable to Los Californianos
 for either $35 or $22:
(1) Application fee ($15) & Regular Member annual dues ($20) for a Total of $35 or
(2) Application fee ($15) & Junior Member annual dues ($7) for a Total of $22

Send your completed Application form  and, if you are applying as a descendant,*
completed Preliminary Declaration of Ancestry form/forms  with your check to
Beatriz Wing, Membership Secretary
Los Californianos,
P.O. Box 600522
San Diego, CA 92160-0522
You may also include a "Noticias Request" if you wish.
at this time, please do not send any documents other than the 
forms we provide on the web site or those you may have received 
from the membership secretary.

 Click here to return to Instructions                                                          (1 Oct 2004)