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Friends of "R" House

Membership Application Form

Please print this form and enclose it with your check made payable to: Friends of R House and mail to:

Friends of R House / Shoreline at Mountain View
3070 N. Shoreline Blvd.
Mountain View, CA 94043

Name:________________________________________________________________________

Phone: ( )____________________ Email: ______________________________

Address:_____________________________________________________________________

City:____________________ State:____ Zip: _____________

Types of Membership Price Benefits
Parlor Club $100.00 We are currently in the process of reviewing a proposal for additional Parlor Club Member's benefits.
Newsletter subscription for 1 year. 2 tickets to Member's Party.
Family $35.00 We are currently in the process of reviewing a proposal for additional Family Member's benefits.
Newsletter subscription for 1 year. 2 tickets to Member's Party.
Individual $20.00 Newsletter subscription for 1 year. 2 tickets to Member's Party.
Senior/Student $15.00 Newsletter subscription for 1 year. 2 tickets to Member's Party.

Membership type: $_________ X ___ (# of memberships) = $____________

I would like to enclose a special donation towards acquiring furnishings: $____________

Total: $____________

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The Rengstorff House
3070 N. Shoreline Blvd.
Mountain View, CA 94043

Phone: (650) 903-6392
www.r-house.org