Choose Membership:                              Regular :       $110.00 (January 1 – December 31)
                                             Student   or  Retired :      $  55.00  (January 1 – December 31)
Name:  Phone: 
Title:  Fax: 
Company Name:  E-Mail: 
Address:  City & Zip: 
Your Product / Service: 
Check Committees of Interest:     Dinner Dance  Education  Golf
   Membership  Legislative  Reception
   Seafood Feast  Programs / Awards
  Please indicate if you would like to have your
  Name and Company affiliation included on our website.		  
Charge my credit card as listed:         
    or a Check (payable to Propeller Club) in the amount of   
NOTE:  If paying by check - please print your completed form
and include your check when mailing it to our office
Name on Credit Card or Check: 
Card Number: 
  If mailing -  Signature of Applicant:   ________________________________________________
  Propeller Club Referred by: 

If mailing - print this form and mail with your check to the address listed below:
Propeller Club of Los Angeles-Long Beach, P.O. Box 4250, Sunland, CA.  91041

Phone:  818.951.2842  *  Fax:  818.353.5976  *  Email:  propellerclub.lalb@verizon.net