HomeMy WebLinkAbout05 Public CommentsORIGI;JAL
MT VERNON AVE PRIDE ASSOCUTION
637 N. MT VERNON AVE.
SAN BERNADINO, CA. 92411
(909) SM2791
Gil Navarro - President (909) 787 -6027 Alfredo Enciso - Treasurer (909) 888 -2791
NAME: PHONE #:
ADDRESS: ZIP CODE:
REGISTERED VOTER: YES NO AGE:
SIGNA11JRE: DATE:
ANNUAL DUES :
A) S 1.00 or more per Year:
B) No Charge for Low Income:
C) 5.00 or more per Family
D) 15.00 or more for Business
Organization:
ADD7770NAL FAMILYMEMBERS ;
.
NAME:
AGE:
YES
NO
NAME:
AGE:
YES
NO
NAME:
AGE:
YES
NO
NAME:
AGE:
VIES
NO
NAME:
AGE:
YES
NO
NAME:
AGE:
Y]IS
NO
NAME:
AGE:
YES
NO
NAME:
AGE:
WS
NO _
NAME:
AGE:
YES
NO
NAME: _ _
AGE:
YES
NO