Whitely Community Council Membership Application

Membership Type?

Family or Individual - $15 Non-Profit Organization or Church - $35 Business - $50

Family or Individual

Name*

First Name

Last Name

Email*

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Contact Phone Number*

Do you live in Whitely?

Yes No

Are you interested in serving on a committee?

Yes No

Would you like to receive email from the Whitely Community Council?

Yes No

Would you like to receive text alerts about meetings and events in the neighborhood?

Yes No

Non-Profit Organization or Church

Organization Name

Name*

First Name

Last Name

Email*

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Contact Phone Number*

Is your business or organization in Whitely?

Yes No

Are you interested in serving on a committee?

Yes No

Would you like to receive email from the Whitely Community Council?

Yes No

Would you like to receive text alerts about meetings and events in the neighborhood?

Yes No

Business

Company Name

Name*

First Name

Last Name

Email*

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Contact Phone Number*

Is your business or organization in Whitely?

Yes No

Are you interested in serving on a committee?

Yes No

Would you like to receive email from the Whitely Community Council?

Yes No

Would you like to receive text alerts about meetings and events in the neighborhood?

Yes No

Applicant Signature*

[clear]

Use your mouse or finger to draw your signature above

QTY