MEMBERSHIP APPLICATION FORM

Name: _____________________________________________

Address: ____________________________________________

Phone (H): ________________________Phone (W): ________________________

YEAR 2002 ANNUAL DUES NOTICE

Suggested Annual Dues Per Household: $20.

Annual Donation: $___________________

Please make your checks payable to: Locust Valley Civic Association

Print out this form and mail with your checks to:
Locust Valley Civic Association
PO Box 274
Locust Valley, NY 11560-0274

PLEASE NOTE: The scheduled $20. per household provides the needed revenue to offset all necessary administrative costs involved in maintaining correspondence, advertising, PO Box, stationary, and other miscellaneous items. We rely on individual donations to continue our efforts, which contribute to maintaining the best quality of life in our great community.