Membership Form

Please print this form, complete it, and mail with annual dues to:
Sacramento Valley RPCVs
P.O. Box 161163
Sacramento, CA 95816

Make checks payable to Sacramento Valley RPCV.

Name:__________________________________________________________________

Street Address:___________________________________________________________

City, State, ZIP:___________________________________________________________

E-mail:__________________________________________________________________

Phone Home:___________________________ Work:_____________________________

Current Occupation:_________________________________________________________

Country of Service:________________________ Years of Service:_____________________

Peace Corps Occupation:______________________________________________________

Select a membership category:
___ Individual, local only ($15) ___ Family, local only ($20)

I am enclosing an additional tax-deductible gift of $______ for Sac Valley RPCV project funding.

Check here if you do not want your name shared with other organizations: ___