Coachella Valley Hiking Club

Application

I hereby apply for membership in the Coachella Valley Hiking Club (CVHC). I agree to be solely responsible for my own safety and well being while participating in activities of the CVHC.

Individual Membership $25.00 annual dues

Family membership $35.00 annual dues

(Please list all names of family members)

Please make all checks payable to CVHC. Send application and check to CVHC, P.O. Box 10750, Palm Desert, CA., 92255

Print or Type (The asterisk denotes the information we really need)

Last Name _______________________________________*

First Name _______________________________________*

Last Name (Family Member) _________________________

First Name (Family Member) _________________________

Last Name (Family Member) _________________________

First Name (Family Member) _________________________

Last Name (Family Member) _________________________

First Name (Family Member) _________________________

Street Address _____________________________________*

Apt. No. _____________ City _________________________*

State __________________________ Zip ________________*

Home Phone Number _________________________________*

E-mail_____________________________________________*