Belmont Shore Residents Association
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Belmont Shore Residents Association Membership Form

If you are not currently a BSRA Member, please take time to print this page, complete the form and mail it with your $20 membership dues (check) to the PO Box address below -- or bring the completed form with you to the next BSRA meeting.


Name:  _______________________________________________

Name:  _______________________________________________

Address:  ______________________________________________________

Phone:  _________________________  E-mail:  ______________________________


Membership Year: October 1st -- September 30th
(New membership dues paid in August or September applies through the following September.)


*** Help the BSRA Work for You ***
DUES  $20.00  PER PERSON/MEMBERSHIP
(Multiple memberships are allowed in the same household -- one vote per membership.)

The issues that concern me most are:

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

Yes, I am interested in assisting the BSRA in the following manner:


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- Belmont Shore Residents Association PO Box 30327 Long Beach CA 90853 -

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