Active Membership Form

Please print information as clearly and completely as possible. When it asks for Primary or Secondary club, remember that the primary club is the club through which the member pays his/her Association dues.

Current Member? Yes / No                         Life Member? Yes / No

If Current Member, please write Member #:________________

Members Full Name:___________________________________________________________

Spouse / Co-Member Name:__________________________________________________________________________

Address:_______________________________________________________________________

City:___________________________________State:__________Zip:____________________

Phone:(______) __________________E-mail address:______________________________

Vehicle Make & Model:___________________ Vehicle Lic.#:_____________________

Primary Club:__4x 4Him Christian Wheelers__ Secondary Club:______________________

Date Joined:___________________Refferred by:__________________________________

Child’s Name:______________________________________________Age:_______________

Child’s Name:______________________________________________Age:_______________

Child’s Name:______________________________________________Age:_______________

Pro-rated Dues = $3.75 per month of remaining Fiscal Year (July-June) or $45 per year if starting in July.

AMOUNT PAID:___________( Make Checks out to "CA4WD, Inc." )

Please fill out application and mail to:                                                                             Jason Strachan (4x 4Him CW)       5670 E. Bernadine.     Fresno, Ca 93727