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RSTB Membership Form

Please print out this form, fill it out, and mail it with your payment to:

RSTB
P.O. Box 630445
Simi Valley, CA 93063

(Your tax-deductible membership dues check should be made out to: Rancho Simi Foundation)


Please enroll me as a New (   ) or Renewing (   ) member of the Rancho Simi Trail Blazers,
for the annual donation fee of (circle one):

Single.... $10     Family.... $15

Please list names and birthdays for all members (Day & Month Only):



Street Address:

City, State, ZIP:

Phone (work/home):

Email Address:

Would you like to receive periodic email announcements
about club activities? Yes (   )  No (   )

How did you find out about the RSTB?: