Tri-Valley
Japanese American Citizen's League
2008 Membership
Application
Date _____________
Name ______________________________________________________________
(Member's Full Name)
Name ______________________________________________________________
(Spouse's Full Name)
Address ____________________________________________________________
E-mail
________________________ Phone _____________________
_______Individual__ $60_______________________________________________
_______Family_____$105
_______Student____$25________________________________________________
Discount for Internet or Electronic Distribution <$5>
Children’s names & year of birth:
How did you find out about us? __________________________________________
_______Check here if you wish
to have your name and occupation published in the Tri-Valley Members Roster (for members’ use only).
Occupation ___________________________________________________________
Checks
are payable to:
Tri-Valley JACL
Mail to:
Cynthia Nitta-Roe
3212 Vera Cruz Drive.
San
Ramon, CA
94583
