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Name _________________________________________ Date:____________

Address: ___________________________ City: ________________________

Home Phone: ___________________ Bus. Phone __________________

Membership: Single: _____ ($7) Family: ______ ($14) (See prorated dues schedule below)

Email____________

Name and ages of family members if family membership: _________________________________________________________________

________________________________________________________________

I (We) are interested in serving on the following committee or activity.

Awards _____ Check Points _____ Historian _____ Membership _____

Newsletter _____ Planning _____ Publicity _____

Other _________________________________

I (We) may be interested in running for the following offices:

President ____ V. President ____ Secretary ____ Treasurer ____ Member at Large _____

My interests are: Walking ____ Biking ____ Swimming ____ Cross Country Skiing ____

Signature: __________________________________________

*Our dues period is from January 1 through December 31 of each year. Dues are prorated on a quarterly basis for new members.

Make check payable to Vaca Valley Volks and mail to Bud Simmons, 304 Creekview Court, Vacaville CA 95688.