Membership application for the 2007 Season

(July 1, 2005-June 30, 2007)

 

 

 

Individual Membership $40.00 (per person)

 

Family Membership $50.00 (consisting of Husband, Wife, 2 children) Third and on will be extra $5 for shirt only

 

Fill in name(s) – 1 Family or Person Per Application:

 

 

Last Name(s) First Name(s)

 

______________________________________________      ___________________________________________

 

______________________________________________      ___________________________________________

 

______________________________________________      ___________________________________________

 

Street Address:_____________________________________________________________________________

 

City:_______________  State:______  Zip:__________  Phone#_________________

 

Email:_______________  B-day________

 

I am enclosing payment in the total amount of $40.00/individual or $50.00/for family.

 

PLEASE MAKE ALL CHECKS PAYABLE TO: MALOSOS SO. CAL RAIDERS BOOSTER

Mail your payment and completed application to:

 

Malosos So. Cal Raiders Booster Club

c/o Jose Vasquez, Treasurer/Membership Chairperson

Baldwin Park, CA 91706