For the civic-minded community

GREATER CALVERTON CIVIC ASSOCIATION         

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Membership

Membership Application

 

Last name: _____________________________________________________

 

First name:  ____________________________________________________

 

Spouse first name:  _______________________________________________

 

If Business, Business name:  _______________________________________

 

Address:  ______________________________________________________

 

City, State, Zip:  Calverton, NY 11933

 

Phone Number:  _________________________________________________

 

Cell Phone Number:  _____________________________________________

 

E-Mail Address:  ________________________________________________

 

Membership dues are $10 per Family or $25 per Business yearly.

Please make check payable to:  Greater Calverton Civic Association, Inc.

 

Amount Enclosed:

 

(   )   Family $10

(   )   Business $25

                                                    (   )   Other $ ___

 

MAIL TO:

Greater Calverton Civic Association, Inc.

 P. O. Box 33

 Calverton, NY  11933