MEMBERSHIP APPLICATION

Name ____________________________________________________

Address ___________________________________________________

City/State/Zip ______________________________________________

Telephone _(______)_________________________________________

Your AMCA membership number_____________________________

You MUST be a National AMCA Member to join the SoCal Chapter of the AMCA

** Enclose a check or money order for $15.00 for Chapter Membership

Please make checks payable to SoCal Chapter AMCA

Mail your SoCal Chapter Dues to:

SoCal Chapter AMCA

c/o Tom Hart

6011 Fairbrook Street

Long Beach, CA 90815

Please send this Application form with your check

For More Information Call: Tim Graber (949) 642-9682

Marc Gallin (714) 531-0960