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Print out this form and reply to the address listed below.

You do not need to own your home to join! A membership in the HNWA costs a household only $12.00 per year payable on September 1. Dues will be prorated at $1.00 per month, as follows:

September - $12.00

October - $11.00

November - $10.00

December - $9.00

January - $8.00

February - $7.00

March - $6.00

April - $5.00

May - $4.00

June - $3.00

July - $2.00 or $12.00  (good through next September).

August - $1.00 or $12.00

 

___YES, please register my household as a member of the HNWA.

___YES, I would like to volunteer for ___________________________ (We will contact you.)

Name: ___________________________________________________________

Address: _________________________________________________________

Spouse (Roommate) Name: __________________________________________

Home Phone: ____________________Business Phone:_____________________

Other Phone: _____________________What?:____________________________

Other Phone: _____________________What?:____________________________

Emergency Contact:___________________________Phone:_________________

Emergency Contact:___________________________Phone:_________________

Email (for news updates):________________________@____________________

If anyone living at this residence is dependent on electricity, please check here_____

Make checks payable to the HNWA and send to:

HARTSDEL NEIGHBORHOOD WATCH ASSOCIATION
PO BOX 15071
DEL CITY OK 73155-5071