The SOUTHERN CALIFORNIA SECTION of USITT

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Membership Form

Southern California Section of USITT

Mail this form and payment to:
Southern California Section, USITT
PO Box 2197
Costa Mesa CA 92628

Make checks payable to: Southern California Section, USITT

Name
Company/School
Title
Address
City, State,ZIP
Phone (W)
Phone (H)
Fax
E-Mail

___ New Member       ___ Renewal

___	Individual	($15)
___	Joint	($20)
___	Non Profit Organization	($30)
___	Student*/Retired	($10)
___	Sustaining	($50)
___	Contributing	($100)

___ Please send me information on National USITT membership benefits.
___ Please send an invoice for accounting purposes.
* Students please include a photocopy of your student ID with a faculty members signature to confirm your status.

E-MAIL

Mail this form and payment to:
Southern California Section, USITT
PO Box 2197
Costa Mesa CA 92628