Please Print this page and send it with your check. Central California Chapter of A.T.H.S. Please Print Clearly New Membership______                 or Renewal______ First Name ____________________ Mi. _______ Last Name ____________________ Suffix _____ Mailing Address_________________________________ City ____________________ State/Province_______________   ZIP/Postal Code________________ Phone Number with area code (____)____-_______ Email Address___________________________________ If you own a truck Please List I Do not own a truck___________ Year_______Make________________Model ________________ Year_______Make________________Model ________________ Year_______Make________________Model ________________ Additional trucks please list on back of this form Chapter Information Yearly Chapter Dues$15.00(Renewal date Dec. 31 each year) Please make checks payable to A.T.H.S Central California Chapter C/O William G Yoder II ---- ATHS Chapter Treasurer 4132 Alan Drive North Highlands California 95660 ATHS By-laws State that all local members must also be national members in good standing.

Central California ATHS Chapter Membership Application