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