ASHRAE: Southern California

MEMBERSHIP/DUES FORM 2010 - 2011
Membership will be good from July 1st 2010 to June 30th 2011

Chapter Year: $60.00 Students: $10.00 Life Members: N.C.

- ROSTER INFORMATION -

Name:

Spouse:

Firm:

Business Address:

City:

State:

Zip:

Phone:

Fax:

E-mail:

Society Membership Number:

Society Grade:

Presidential
Life
Fellow
Member
Associate
Affliliate
Student

Indicate First, Second and Third Choice for Committee Assignment:

First Choice:

Second Choice:

Third Choice:

If 'Other' Please specify:

MAILING INFORMATION:
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Firm:

Street Address:

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Total Enclosed $:

Make checks payable to:

Southern California Chapter, ASHRAE
P.O.Box 80133
San Marino, CA 91118