Membership form


                                      Chartered to represent the La Canada, LaCrescenta, Montrose, Sunland Tujunga Foothill Communities 

Affiliated with The California Republican Assembly

Meetings held 4thnd Wednesdays 6:30 p.m.

Social hour:  Dinner, Entertainment & Cash Bar: 6:30-7:00 pm

Speaker Program 7:00 -8:30 p.m.

4004 La Crescenta Ave, La Crescenta, CA 91214 --Accessible Parking & Entrance

Membership Form 

Please Print Legibly


Name:___________________________________________________________________________________


Name:___________________________________________________________________________________


Address:_________________________________________________________________________________


Home Phone: __________________________   Cell Phone:________________________________________

Print Email Address(es)  for monthly e-newsletter/notices

email_____________________________________________________________________________________


email_____________________________________________________________________________________


New Member ____              Renewing  Member ____

Membership type:   Single $25 _______   Couple  $40 _______Student $15________

Please Make Check Payable to GBRA

Send Form and Check to:

GBRA c/o Sonny Sardo 1361 Foothill Blvd, La Canada  91011

For additional information please call 626-823-4679

Please call me, I am interested in volunteering ____

I am contributing  an extra amount $_________________________