Complete the form, enclose with a check made out to CCHC for dues of $15 per person or $10.00 each for two or more persons living at the same address, and mall to Membership Secretary:

Marie Alberti
2946 Ashby Avenue
Berkeley CA 94705
510-845-2445

NAME(S) __________________________________________________________________________________

ADDRESS _______________________________ CITY _________________________ ZIP ________________

TELEPHONE NUMBER ________________________ e-mail ___________________________