Membership Renewal Form For Fiscal year beginning April 1, 20_____
Monrovia Rockhounds
P.O. Box 553
Monrovia, CA 91017-0553
Please print your information. Use only the address above if you are renewing by mail and please do not mail cash.
NAME________________________________________________________________
FULL ADDRESS________________________________________________________
( ) I want my address on the roster ( ) I do not want my address on the roster
HOME PHONE: ______________________________
CELL PHONE: _______________________________
( ) I want my phones on the roster ( ) I do not want my phones on the roster
BIRTHDAY: (month/day only) ________________
( ) I want my birthday on the roster ( ) I do not want my birthday on the roster
E-MAIL ___________________________________________
( ) I want my email on the roster ( ) I do not want my email on the roster
FIRST/LAST NAMES OF FAMILY MEMBERS:
______________________________________________________________________
Renewal Fees Individual Membership $20.00………………………………$_________
Each additional person in same household $10.00 each ...$_________
Amount of dues received $________ Check #________ Cash $_______ Date________
Received by (signature) ________________________________