ALAMEDA  NORTH  VALLEY  ASSOCIATION

MEMBERSHIP INFORMATION

DATE:  ___________________________________________________________________________

NAME:  ___________________________________________________________________________

ADDRESS:  ________________________________________________________________________

CITY,  STATE,  ZIP:  _________________________________________________________________

PHONE:  ______________  Email address:  ______________________________________________

NEW MEMBERSHIP?   _______        RENEWAL?    _______

 

SIGNATURE:    _________________________________________________________________________

INTERESTS:  ___________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

Please remit $15 annual membership dues to:

Debi Hale, ANVA Treasurer
9359 Guadalupe Trail, N.W.
Alameda, New Mexico 87114
Phone: 505/ 897-1566