2023/24 Membership Application
Fill out the form completely and Make Payment via check or on-line. www.pointlomaassembly.org - 501(c)(3), Tax ID #95-2477318
Status for July 1, 2023 - June 30, 2024
$100 Renewing (*Contact information needed only if changed)
$100 New Member ($50 after January 31)
$150 Household (2 people at same address, 1 voting member - ($75 after January 31, 2024)
Member information Update only
Name
First Name
Last Name
Address*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail*
example@example.com
Phone Number for Directory*
Include me in the Directory*
Yes
No
I am interested in in helping with the following:
Donations/Fundraising
Membership
Programs
Publicity
Refreshments
Social Media
Social Functions & Special Events
Other
Submit
Should be Empty: