Summit West Neighborhood Association

Membership Form

As a resident in our neighborhood, we want you to be a member. Becoming a member costs nothing and makes sure your voice will be heard. Please fill out the form and return to the address listed below. Each person must complete a separate application. Members are allowed one vote only. Members in the neighborhood association include residents and businesses. If you have questions about the association or becoming a member, please see the bylaws.

We will not release your information without your permission. It is important that you fill out the entire application, because it is easiest for us to contact you by email. Our neighborhood does not charge dues, and mailing is expensive.

Basic Contact Info

Full Name:
Phone:
Email:

Street Address

Street Address Line 1:
Street Address Line 2:
City, State:	,
Zip:

Mailing Address (if different from above)

Mailing Address Line 1:
Mailing Address Line 2:
City, State:	,
Zip:

Neighborhood: Summit West Bend

Issues I am interested in:

Areas I want to volunteer in:

I currently reside within the boundaries of Summit West Neighborhood Association and have done so for a minimum of 30 days. I am 18 years of age or older.

Name: Date: