Fountain Valley and New

Beginning Membership

Form

Thursday, January 31, 2002 6:24:39 PM

Enter Your First Name…………..

Enter Your Last Name……………

Your Mailing Street Address…….

State Address……………………..

Zip Code…………………………..

amount paid

Cash…..Money Order…..Visa….

Memberships are $10.00 and must be paid in full

Your Signature:……………………………………..

Date:…………………………………………………