Last updated: September, 2008 PLEASE PRINT CLEARLY Your name: _________________________________________ Date of Birth: mo___/day___ Partner’s name: _________________________________________ Date of Birth: mo___/day___ Mailing Address: ________________________________________________________________ City: _________________________________________ State: _________ Zip: ________-_____ Phone Numbers: Home __________________________ Others __________________________ Email: _______________________________________ Anniversary: mo___/day___/year_____ List your hobbies, interests, specialties: ______________________________________________________________________________ ===================================================================== Signature #1 ___________________________ Signature #2 ___________________________ ===================================================================== Membership dues are $45.00 per couple for the first year; $40.00 each year thereafter. New memberships/renewals will run for one full year from the month the couple joins or renews. Two photo badges are included in your 1st year membership dues. Badge pictures are taken at CVC events. Please make check payable to Coachella Valley Couples sending it along with this application to: CVC, P.O. Box 4104, Palm Springs, CA 92263-4104 If you require assistance with paying the annual dues, please include an explanation with your application. COACHELLA VALLEY COUPLES A Social Organization for Committed Gay and Lesbian Couples Contact Sam and Tedd, Member Services Couple 760-329-7895; TEAMSAMM@roadrunner.com Please check one: _ New Members _ Renewal Today’s Date: ___/___/___ CVC in no manner subscribes to nor supports any discrimination except that individuals under the age of 18 shall not be eligible for general membership. By joining CVC, I release and discharge CVC and the officers from all claims in any manner arising out of property damage and personal injuries sustained by me as a result of participating in any club activity. I waive the right to every lay claim for injuries I might suffer before, during or after any club event. Our photographs may appear in the CVC newsletter and/or website as participants at CVC events. MEMBERSHIP/RENEWAL APPLICATION Our Mission Statement: Coachella Valley Couples (CVC) is an organization in which the members are committed gay and lesbian couples of the Coachella Valley in Southern California and beyond. This Organization serves to provide a forum for those member couples to strengthen their own relationships while providing a social and supportive structure for their fellow member couples. CVC holds no religious or political affiliations and makes every attempt to respect the privacy of its members.