WEST SAYVILLE CIVIC ASSOCIATION

MEMBERSHIP APPLICATION

NAME:________________________________________________________

ADDRESS:____________________________________________________

________________________________________________________________

EMAIL:_______________________________________________________

TELEPHONE:________________________________________________

CELL PHONE:________________________________________________  

HOUSEHOLD MEMBERS:____________________________________

________________________________________________________________

COMMENTS/CONCERNS:___________________________________

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_____NEW MEMBER

____RENEWAL

Membership in the WSCA is $25.00 per year per household.

Please make checks payable to WSCA

P.O. Box 118

West Sayville, NY 11796