APPLY TO JOIN!

NAME:         ___________________________________________________________________
        
HOME ADDRESS:         ___________________________________________________________________
        
MAILING ADDRESS:       ___________________________________________________________________
        
HOME PHONE:         _________________      WORK PHONE:  _______________
        
E-MAIL ADDRESS:        
___________________________________________________________________

EMPLOYER:         ___________________________________________________________________
        
PROFESSION:         ___________________________________________________________________
        
GUEST OF:         ___________________________________________________________________
        
SPOUSE'S NAME:         ___________________________________________________________________
        
BIRTH DATE & PLACE:   ___________________________________________________________________
        
OTHER CLUBS AND ORGANIZATIONS YOU ARE AFFILIATED WITH:
        
___________________________________________________________________
        
___________________________________________________________________
        
IF YOU HAVE MOVED TO BISHOP WITHIN THE LAST YEAR, WHERE DID YOU
PREVIOUSLY LIVE?
        
___________________________________________________________________
        
PLEASE WRITE A PARAGRAPH ABOUT YOURSELF, INCLUDING YOUR TALENTS AND HOBBIES:
        
___________________________________________________________________
        
___________________________________________________________________
        
___________________________________________________________________
        
___________________________________________________________________
        
___________________________________________________________________
                


SIGNATURE: __________________________________________  

DATE:_________________

Please print out and send this sheet along with a check for $90 to:
Altrusa of the Eastern Sierra
PO Box 1795
Bishop, CA  93515