PWA Membership Form
Primary Member Name
*
First Name
Last Name
Primary Email
*
Confirmation Email
Confirm E-Mail Address
Primary Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
2nd Member Name
First Name
Last Name
2nd Email
Confirmation Email
Confirm E-Mail Address
2nd Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
3rd Member Name
First Name
Last Name
3rd Email
Confirmation Email
Confirm E-Mail Address
3rd Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Pond Association
*
Please Select
Oldham Pond
Stetson Pond
Furnace Pond
Little Sandy Bottom Pond
Hobomock Pond
All Ponds
Would you like to help/volunteer?
Pond Clean-Up Events
Website Development/Maintenance
Membership Drives
Water Quality Testing
Annual Raffle Drive
Other
Memberships:
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Primary Membership
$20.00
$
20.00
Second Household Member
$10.00
$
10.00
Third Household Member
$10.00
$
10.00
Choose a payment method below
NOTE that the PayPal link will allow you to pay by PayPal or Venmo.
Payment Methods
Debit or Credit Card
Choose from one of the PayPal options to
make your payment.
Submit
Should be Empty: