SEMIAHMOO LADIES CLUB

2012 Membership Dues and Roster Information

Please return this form with your dues by February 15, 2012

Semiahmoo Ladies Club 2012 Membership dues: $40.00  (tax deductible)

New Members: $45.00 ($40.00 membership which is tax deductible and $5.00 roster binder) 

Please make you check payable to: SEMIAHMOO LADIES CLUB and mail to: Daphne Johnson, 4550 Birch Bay Lynden Road, PMB F-133, Blaine, WA 98230.

Roster Information

*If there are no changes in your roster information,

 please enter your name only .

*Name:______________________________

Husband’s name:______________________

Home Phone:_________________________

Cell Phone:___________________________

Address:__________________________________________________________________

Mailing Address (if different):___________________________________________________

E-Mail:______________________________ 

Birthday (month and day):________________

2^nd Address (if any):__________________________________________________________

Phone: ______________________________

The Semiahmoo Ladies Club roster is for social purposes only and should not be used or sold for business purposes. 

_________ I regret that I will not be renewing my membership for this year