Join Assistance League of Santa Clarita To join Assistance League of Santa Clarita please fill out the form below, then click NEXT to pay the required annual $75 membership dues.If you have any questions, please feel free to contact us. URLThis field is for validation purposes and should be left unchanged.Member InformationName* First Last Date of Birth *Date of Birth*MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberDay*Day12345678910111213141516171819202122232425262728293031Address* Street Address City State State*AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Main Phone*Additional PhoneEmail* Emergency Contact InformationName* First Last Relationship*Main Phone*Other PhoneInterests and SkillsPhilanthropic Programs / Fundraising InterestsSpecial Skills & Training (e.g. finance, computer skills, merchandising, etc.)Type of Member / Remittance AmountMembership Type Voting Member Non-Voting Member Policy & ProceduresPlease check each box to acknowledge your agreement.Whistleblower Protection Policy of Assistance League of Santa Clarita.* I have read and agree to abide by the Whistleblower Protection Policy of Assistance League of Santa Clarita. Ethics Policy of Assistance League of Santa Clarita.* I have read and agree to abide by the Ethics Policy of Assistance League of Santa Clarita. Protected Persons Policy of Assistance League of Santa Clarita.* I have read and agree to abide by the Protected Persons Policy of Assistance League of Santa Clarita. Conflict of Interest Policy of Assistance League of Santa Clarita.* I have read and agree to abide by the Conflict of Interest of Assistance League of Santa Clarita. Do you have a conflict of interest to report?* YES - I have a conflict of interest to report No Please explain what your conflict of interest is.Self-Dealing Policy of Assistance League of Santa Clarita.* I have read and agree to abide by the Self-Dealing Policy of Assistance League of Santa Clarita. Photo and Name Release*Assistance League of Santa Clarita has my permission to include my name as a member of and/or donor to Assistance League in its printed materials such as chapter newsletters, event invitations or programs, press releases, etc. Assistance League also has my permission to use any photographs of me taken in connection with Assistance League activities in its printed materials. Yes No Insurance Waiver*I understand that I am required to provide my own health and accident insurance. Assistance League of Santa Clarita is not responsible for any medical or legal expenses that may result from any injury or illness that I may sustain while participating in Assistance League activities. I also agree that I shall maintain adequate personal automobile insurance while using my own vehicle for Assistance League of Santa Clarita business and shall not hold Assistance League liable for any claims that may result from accidents occurring while I am using my own vehicle for Assistance League business. Yes No SignatureCAPTCHA