CO-REC CLUB Membership Application

CO-REC CLUB Membership Application Community Services Department
Name
Address
City	Zip
Phone (         )
Birthdate (mm/dd/yy)	Age
Grade in September
School in September
Please Check One:	[  ] Renewal    [  ] New
Membership Fee: $15.00 A copy of a school schedule or school ID is mandatory with all applications Please make check payable to: City of Torrance, Co-Rec Club 3031 Torrance Boulevard, Torrance, CA 90503