Application for MembershipThe California Pioneers of Santa Clara County
Fill out this form and PRINT and mail with check.

Membership applying for :
If elected to membership, I promise to conform to the By-Laws, Rules, and Regulations

My Name is:

Maiden Name
-- if applicable:

My Date of Birth:

 Date Arrived in California:

 I am a Native of:

 My Occupation is / was:

Name of Pioneer
Ancestor (s):

Date Parents Came
to California:

 Mother: Father:

My Telephone
Number is:

 ( ) Alternate: ( )

My Email Address is:

My Address is:

City: State: Zip: ( 9 digit Zip please )

Mailing Address
--Only if different :

  City: State: Zip: ( 9 digit Zip please )
Proposed By:
(Signature of Member of the Pioneers)		 Endorsed By: 
(Signature of Member of the Pioneers)
 Signature:
(Signature of Applicant)		  Date:

Please include breif historical information
on the back of this page.
  Accepted (Date):

 
 If information is correct:
PRINT FORM -- INCLUDE PAYMENT BY CHECK OF FEES [ schedule of fees click here ]
MAIL TO: Pioneers, Attn: Robb Moore, P.O. Box 8208, San Jose, CA 95155-8208
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