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Membership Application Form |
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>PLEASE PAY 2003 DUES BY JANUARY 3, 2004<
$15.00/Person $25.00/Couple |
NAME(S)
Mr.
_________________________________________________________
(First) (Last)
Mrs./Ms.____________________________________________________
(First) (Last) |
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Complete this form, detach, add check,
and give to the Treasurer at the next meeting—OR mail to:
Membership Committee
Big Pine Key Civic Association
P.O. Box 430190
Big Pine Key, FL 33043-0190 |
Local
Mailing ________________________________________________
Address (Number) (Street)
-with-
9-Digit _________________________________________, Florida
ZIP code (City)
(if available): ___________________ - ___________
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c - I
verify that I live at least 4 months of each year on Big Pine Key or No
Name Key and request
REGULAR MEMBERSHIP
With voting and other membership rights as indicated in the
By-Laws of the Association.
c
- Owner - OR - c
- Renter |
If
the above address is a P.O. Box, indicate below your actual residence:
Home Address
__________________________________________________________
(Number) (Street)
______________________________________________,___________
(City) (State)
ZIP Code: _____________________-____________
9-Digit (if available.) |
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c I do not
reside at least 4 months of each year on Big Pine Key or No Name Key but
I request
ASSOCIATE MEMBERSHIP
Which provides for newsletters and opportunities to
participate in community improvement programs.
I am aware that I will not have voting rights or be permitted to serve
on the Board of Directors. |
I
/ We support the Mission Statement and request membership.
Signature(s):
_____________________________________________________________
(His)
_____________________________________________________________ (Hers) |
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Local Phone: (________)__________-________________ |
c
I have also enclosed an extra donation of $___________
c
I wish my gift to be anonymous |