LOS CALIFORNIANOS

APPLICATION FOR CORRESPONDING MEMBERSHIP

 Name of Organization:                                                                           

                                                                                                               

Mailing Address:                                                                                        

                                                                                                                 

                                                                                                                

                                                                                                                 

Billing address, if different :                                                                       

                                                                                                                

                                                                                                                

                                                                                                                

Contact Person, if you wish to specify:                                                      

                                                                                                               

Phone Number:                                                                                        

E-mail address:                                                                                        

Begin membership immediately ? ___ or begin next calendar year ? ______

Signature: _______________________________ Date: _____________

Please mail this form accompanied by a check payable to Los Californianos
including the $15.00 application fee plus an annual fee of $20.00, total $35.00,
which will be for a calendar year to:
Beatriz Wing, Membership Secretary
Los Californianos
P.O. Box 600522
San Diego, CA 92160-0522

Click here to return to Instructions                                                  (15 July 2002)