5721 CRESTRIDGE ROAD, RANCHO PALOS VERDES, CA 90275
310) 377-6986     FAX: (310) 541-1370

Mens Club Registration - 2011 - 2012
Dues $36.00
Note: Dues now include cost of Breakfasts (when Morning meetings are held at Ner Tamid)
 Name: ___________________________________ Home Phone #: ____________________

Work Phone #:_____________ Cell Phone #: _____________ FAX #: ________________

Address: ___________________________________________________________________

City: ____________________________________  State: ________    Zip: ______________

Email Address(es): ________________________________________________________

NOTE: E-mail addresses are our primary means of communication. They are for official Men’s Club business only, and will not be published, sold, or distributed. Please be sure they are correct and notify us of any changes.

Your Age: __________  # of Children: _________    Their Ages: ___________________

Hobbies and Interests:_________________________________________________________________

Suggested Mens ClubTopics: _________________________________________________________

Suggested Mens Club Activities: ______________________________________________________

Activities or Jobs You Would Be Willing To Help With: ____________________________________

I am interested in being on the CNT Mens Club board (Circle one):   yes   no

Please return this form with your check for $36, made out to:
Congregation Ner Tamid Mens Club
5721 Crestridge Rd, Rancho Palos Verdes, CA 90275


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or

Download this application form along with a Men's Club Letter from
the mens club president.

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