EBELL CLUB DUES & DIRECTORY VERIFICATION

P.O. Box 422 Laguna Beach CA 92652

Name of Prospective Member

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Phone

(###)

###

####

Email Address

Birth month and day

Spouses name and Occupation

ANNUAL MEMBERSHIP DUES - Due by July 1, 2023

Payment Amount:

Active Membership: $85
Sustaining Membership (eligible after 3 years): $65

Make check payable to “Ebell Club of Laguna Beach” and mail to:

Ebell Club of Laguna Beach
Membership Chair
PO Box 422
Laguna Beach, CA 92652

(online payment coming soon)