Membership Form

MEMBERSHIP FORM
$5.00 PER PERSON
*All information will remain confidential.*

(membership expires on November of each year)


Full Name: _______________________________________________________________     $__________

Spouse’s Name: __________________________________________________________     $__________

Address: _______________________________________________________________________

City: ____________________________________ State: _____________ Zip: ______________

E-Mail: _________________________________________________________________________

VP #: ______________________________________   Fax # _____________________________

TTY # _____________________________________

New membership                                    Renewal

Prefer method of receiving news, information, etc from SFCD: (Choose one, please)

Email                                                   Mail           


Make check or money order payable to SFDC and send to:

Jerry Grisby, SFDC Treasure

1391 Le Havre Court

Livermore, CA 94551