FORT TEJON HISTORICAL ASSOCIATION, INC.
2012 MEMBERSHIP APPLICATION
A. thru E. check one – All memberships (A, B & D) include an email subscription to the FTHA newsletter
A. Individual Membership $30.00. Must be 18 years of age or older.
B. Family Membership $40.00. Includes legal spouse and dependent children under age 18. Member and spouse both must
initial and sign general liability release. Membership cards are issued to children 13 years and older.
C. Minor(s) Without Parents. Requires Family Membership $40.00 and completed Guardian Assignment form for each
participating minor. Refer to Section 12 of the FTHA Civil War Rules and Regulations for information regarding minor
D. Day Pass $10.00. Issued to individuals for one event only. Day Pass may be modified to any membership within 30 days
of purchase; forward unpaid balance with Day Pass to Membership Director.
E. Supporting Membership $5.00 Non-participating / non-voting individuals. Receive FTHA newsletter via email.
Complete F thru K only.
PLEASE PRINT LEGIBLY
F. NAME BIRTH DATE Director Use Only
Member ______________________________________________ ____________________________ Event / Mail
Spouse ______________________________________________ ____________________________ Amount Paid
Child ______________________________________________ ____________________________ Cash / Check No.
Child ______________________________________________ ____________________________ Date Data Entered
Child ______________________________________________ ____________________________ Date Card Mailed
Child ______________________________________________ ____________________________ Number Cards Mailed
G. Street Address: __________________________________________________________________
Mailing Address: ________________________________________________________________
City: ____________________________________________________ State: ______ Zip: ____________
H. Home Phone: __________________________________ Work/Cell Phone: ____________________________________
Email 1: ______________________________________ E:mail 2: ___________________________________________
I. Have you been a member of the FTHA in the past? Yes / No
J. Mail the newsletter to me in hard copy (Add $5 to membership fee above)
K. Are you interested in participating on any of the administrative committees or at the post store? Yes / No
NO PERSONAL INFORMATION PROVIDED ON THIS APPLICATION WILL BE SHARED
GENERAL LIABILITY RELEASE ON REVERSE SIDE MUST BE INITIALED AND SIGNED BY ALL ADULT APPLICANTS
MAIL SIGNED FORM AND CHECK PAYABLE TO FTHA TO:
FTHA, POB 630586, SIMI VALLEY, CA 93063-0586