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Date __________________________ NAME(S)_____________________________________________________________________ WIT#__________________________________ ADDRESS_______________________________________________CITY_______________________State____ZIP____________________ PHONE _________________________________ CELL PHONE____________________________ ANNIVERSARY (Mo)______________________ (Yr_____________EXPIRATION DATE_______________________________ LOCAL CHAPTER________________________________________________________E-MAIL ADDRESS_______________________________ NEW MEMBERS: Please enclose $10.00 Initiation Fee plus $10.00 annual dues for a total of $20.00. Make checks payable to: California State Club of WIT RENEWALS Enclose $10.00 annual dues for each year of renewal Check one: _____New Member _____Renewal Send to: Lee Foulk 2681 Cameron Park Drive #116 Cameron Park, CA. 95682 __________________________________________________________________________________________________________________________
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