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2023-24 Affiliate Membership Form
Affiliate Name*
DBA
Mailing Address:*
City, State, Zip*
Please publish my mailing address (Use dropdown to indicate Yes or No)*
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E-mail Address:*
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2023-24 Annual Affiliate Dues $30 or $40 after Nov 30*
Check No., made payable to SCCQG:*
Date Check Mailed to Treasurer, SCCQG, 15619 Ogram Avenue, Gardena, CA 90249. DO NOT send her anything other than the check, with the check purpose on memo line.*
Repeat Email Address