Print out and complete this form, and mail it with your membership dues to the PO Box address below -- or bring the completed form with you to the next BSRA meeting.

Belmont Shore Residents Association Membership Form

If you are not currently a BSRA Member, please take time to
complete and return this Membership Application.  Thank You!

Name:  _______________________________________________

Name:  _______________________________________________

Address:  ______________________________________________________

Phone:  _________________________  E-mail:  ______________________________

Membership Year: October 1st -- September 30th
(New membership dues paid in August or September apply through the following September.)

- Help BSRA Work for You -
DUES  $10.00  PER MEMBERSHIP
(Multiple memberships are allowed in the same household -- one vote per membership.)

Yes, I am interested in assisting BSRA in the following manner:

___________________________________________________________________

___________________________________________________________________

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The issues that concern me most are:

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- Belmont Shore Residents Association PO Box 30327 Long Beach CA 90853 -