Friends of "R" House

Membership Application Form

Please print this form and enclose it with your check made payable to: Friends of R House and mail to:

Friends of R House / Shoreline at Mountain View
3070 N. Shoreline Blvd.
Mountain View, CA 94043

Name:________________________________________________________________________

Phone: ( )____________________ Email: ______________________________

Address:_____________________________________________________________________

City:____________________ State:____ Zip: _____________

Types of Membership	Price	Benefits
Parlor Club	$100.00	We are currently in the process of reviewing a proposal for additional Parlor Club Member's benefits. Newsletter subscription for 1 year. 2 tickets to Member's Party.
Family	$35.00	We are currently in the process of reviewing a proposal for additional Family Member's benefits. Newsletter subscription for 1 year. 2 tickets to Member's Party.
Individual	$20.00	Newsletter subscription for 1 year. 2 tickets to Member's Party.
Senior/Student	$15.00	Newsletter subscription for 1 year. 2 tickets to Member's Party.

Membership type: $_________ X ___ (# of memberships) = $____________

I would like to enclose a special donation towards acquiring furnishings: $____________

Total: $____________