|
Legal Name(s):
| LEGAL NAME (first) _______________________
(last) ________________________ |
| Nick Name (if applicable) _____________________________
|
| Email address ____________________________________________________ |
| Partner Name (if applicable) (first)
_____________________ (last) ______________________ |
Renewal Type:
| ___ Single ($7.00 per year) |
___ Couple ($14.00 per year at same
address) |
Host or co-host fulfillment:
Service to the club, as either an event Host or a Co-host,
once a year is a requirement for membership. Please complete your preference
for service on the lines below:
| Please place my name(s) on the co-host
team for the month of: _______________ |
| or, I (we) will host a party in the
month of: ________________ |
Address / phone changes, if any:
| Address ________________________________________________________ |
| City _______________________________
State _______ Zip _____________ |
| Telephone (home) _____________________
(other) ______________________ |
DO NOT send cash. Please be sure to note any corrections
to your address or telephone number. This form must be received with
your renewal check. Please print and mail this form with a check attached
to:CMEN, 8424-A Santa Monica Blvd. #119, West Hollywood, CA 90069.
|
