MEMBERSHIP RENEWAL FORM

RENEWAL DUES FOR THE YEAR ARE DUE OCTOBER 1,2006 (Please read the entire form before signing and returning)

NCGA has increased club membership dues by $5 for the year2007. .Club Membership Fees will now be $70.00 ($45.00 for Social Member) when paid prior to November 15,. After November 15*, the dues go up $I0.00 to $80.00 ($55.00 for Social Members.) Deadline for the Year for Renewal is December 15,. Make checks payable to Shoreline Seniors Club and mail with lower portion of this application to;

Bruce Fujikawa, 21572 Columbus Ave, Cupertino, CA 95014-4781

Name _____________________Home Phone#___
Street____________________City____________Zip
Birthdate___________NCGA#__________Home Club__"
Email address website

Check one category (applying for): ___Regular Membership ___Social Membership

In applying for renewal, you agree to; (1) comply with the By-Laws, Rules and Procedures of this Clvt (2) abide by all agreements that have been entered into by said Club and all agreements that the Board Directors of this Club enter intto subsequent to the date of application and (3) serve as a greeter at leas once a year, as of the date of application.

Signature_______ ____Date____________