First Name: Last Name:
M
F
Date of Birth: / / Occupation:
Cell Phone: ( )
E-Mail: Signature: ______________________________
First Name: Last Name:
M
F
Date of Birth: / / Occupation:
Cell Phone:
( ) E-Mail: Signature:
______________________________
Address:
Street: City: State: ZIP:
Home Phone: ( )
Family Memberships may include individuals up to
age 23 if living in the same household with parent/guardian. For Family Members
less than 18 years of age at date of application, the attached waiver and
release must be co-signed by the Applicant who is parent or legal guardian. There
is an added $15/person annual fee beyond the first two family members.
DEPENDENT FAMILY MEMBERS (Ages 0 Ð 23 living in same household):ÊÊÊÊ
First NameÊÊÊÊÊÊÊÊÊÊÊÊÊÊÊÊÊÊÊÊÊÊÊÊÊÊÊÊ Last
NameÊÊÊÊÊÊÊ Date of BirthÊÊÊÊ Signature (Parent or Legal Guardian, if
under 18)
M
F
/ / _________________________________________
M
F
/ / _________________________________________
M
F
/ / _________________________________________
M
F
/ / _________________________________________
Membership Fee: (Check one category, with
amount enclosed):
Renewal Add $50 Late Fee if renewing after Sept. 1st Single Mem . Family Mem.
Memb # New and Renewing Provisional
Members
$110
$135 plus $15 per dependent beyond two
(If Renewing) Regular Members
prior to Sept. 1
$50
$75 plus $15 per dependent beyond two.
Check method(s) of Newsletter
delivery:
Via email
Via U.S. Mail (add $12 to Membership
Fee)
All Applicants: Select VOLUNTEER AREAS below of
interest to you. Our All-Volunteer
Club appreciates your help!
**
New members registering after April 1st
will have their memberships extended through June 30th of the
following year.
San Diego County residency is required for membership. Applicants must attend a general
meeting to be introduced and agree to meet with expectations/conditions as expressed in
the attached document entitled ÒProvisional MembershipÓ to be considered for membership
by the Board of Directors. Before new members may stay in the Chalet, they must attend a
Chalet Orientation, be approved by the Board, and pay their membership dues.
Check here to update membership data without renewing.
PRINT, SIGN and RETURN pages
1, 2, and 4 only.
Please send completed
application and signed Waivers/Chalet rules to: damon.ventiere@gmail.com
Damon ÒVinnyÓ Ventiere,
SDSC Membership Chair
13458 Orange Blossom Lane, Poway, CA 92064
Membership Form and Waiver 6-2021
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