La Sierra Guild of Children's Hospital, Central California

Please utilize this form as a Membership Application, Donation, or Both.

We will not share this information except in conducting La Sierra Guild,
non-profit business supporting Children's Hospital, Central California.

NAME:  ___________________         SPOUSE: ________________ (if joining)


STREET: _________________          CITY: ____________ ZIP: __________


HOME PHONE #: _______________  OTHER PHONE #: _______________  


E-MAIL:__________________     BIRTHDAY: MONTH/DAY__________  (if joining)


HOBBIES/INTERESTS____________________________________________ (if joining)


Please circle one:  ACTIVE / ASSOCIATE           


Monies Submitted:  Dues ______;  Badge _______;  Donation  _________



SIGNATURE: ________________________   DATE: ______________


Please print your name as you want it to appear on your Active Member's Name Badge:


___________________________________

Application.  Membership application and the first year's dues of $15.00 are to be submitted to the La Sierra Guild, Attention Membership, P.O. Box 956, Oakhurst, CA 93644.  Badge.  Active members must purchase a name Badge and must include the $12.00 cost of the name Badge with the Membership Application.  Associate Members are not required to purchase a name Badge.  An Associate Member’s Badge will be provided by the Membership Chairman when attending La Sierra Guild meetings and functions.   Each member must wear their Badge at all La Sierra Guild meetings, functions, and when representing La Sierra Guild in public.