Membership Application

Please remember the following when paying your membership fee:

-Pay $75 if your annual budget is less than $1 million

-Pay $200 if your annual budget is $1 million or more


Are you a new member to Meals on Wheels CA?
First and Last Name
Total should equal 100%. Private Funding % Government Funding % Fee for Service %
List their first and last name, position, email address, and phone number for each individual.
I authorize the verification of the information provided on this form. *