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IASJ MEMBERSHIP APPLICATION FORM
PO BOX 78064, STOCKTON, CA 95267
Application For:
__ Family Member ($35/yr) __ Single ($25/yr) __ Honorary (No Fee)
Primary Member's Name: _________________________________________________________________
(Head of the Family) First Middle Last Spouse's Name: ___________________________________________________ Current Address:____________________________________________________ City: ________________________ State: _______ Zip Code: _____________ Home Phone: ________________ Alternative Phone: _____________________ E-Mail Address: ____________________________________________________
Occupation: Your's __________________ Spouse's: ______________________
Interest/Hobbies: Your's: _________________ Spouse's __________________
Other Family Members LIVING with you (Use extra sheet if needed)
Full Name
| Age
| Married (Y/N)
| Relation to Primary member
| Profession
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I hereby apply for the membership of the Indian Association of San Joaquin (IASJ) and pledge to abide by all the`Articles of Incorporation and by-laws of the IASJ, also known as the Indian Association. Neither the Indian Association or its board members including trustees nor the facilities rented by the Indian Association is liable for any kind of personal and/or property damages to me or any of my family mambers or (invited or uninvited) guests.
I certify that the information supplied above is correct and complete to the best of my knowledge. I also authorize the Indian Association to release and publish the above family member information in any future Indian Association Publication(s).
Invited By: _______________________________________________________
I can help with: ___________________________________________________
________________________________________________________________
________________________________________________________________
_______________________________ ______________________________
Applicant's Signature Spouse's Signature
Please mail the completed form to the above IASJ address or give it to any Board Member
For Association Use Only No: __________ Amount $: ______________ Date: _______________
Cash/Check No: _____________________ Approval By IASJ Officer________________________
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