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Name_____________________________________________________ Mailing Address Address___________________________________________________ City______________________ State_____ Zip___________-________ Home Address Address___________________________________________________ City______________________ State_____ Zip___________-________
Email Address_____________________@________________(Not Required)
Telephone Phone #1 (____) ____-_______ Best time to Contact_______________________ Phone #2 (____) ____-_______ Best time to Contact_______________________ Family Information Second Adults Name________________________________________________ Children Under 18___________________________________________________
Type of Membership [ ] One (1) Year Trial Membership $175.00 Time Payments? Refer to membership section on time payments or phone: 530-283-5141- 650-692-1932 or Email: GCMC2002@aol.com
Referrals and Other Memberships Who referred you?____________________________________________________ Do you have any other Assn/Club memberships_____________________________ Signature:___________________________________________________Date___/___/______
Payment Send check or money order payable to: Gordon K. Burton—Owner GCMA |
Association Application |