California Historic Route 66 Association

Membership Application (annual)
(Internet Membership Form)

Individual/Family ($20)______ Outside U.S. ($28)_____
Business ($50)______

Date______________________________   New Member       Renewal

Mail Newsletter to: (please print)

Name_____________________________________________
Address__________________________________________
City_____________________________________________
State________________________________ ZIP_________
Phone(____)______________________________________
Email Address:___________________________________
Affiliation______________________________________

Make checks payable to:

California Historic Route 66 Association
PO Box 1359
Rialto, CA 92377
Phone: (909) 874-9448

Fax:  (909) 874-5947

Inquiries via email to (kickinon66@msn.com)