Household Membership Form
Are you a new member or a renewing member?
*
New Member
Renewal
Unsure
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
WPENA Committee Volunteer Opportunities (Optional)
Communications Committee (Newsletter / Event Newsletter, Website)
Membership Committee
Crime & Safety Committee
Park Issues Committee
Sustainability Committee
Zoning & Regulations Committee
4th of July Committee
Other
How did you hear about WPENA?
*
Please Select
WPENA Newsletter
New Neighbor Postcard
July 4th Event
Summer Yard Sale Event
WPENA Happy Hour
NextDoor
Word of Mouth
Other
By filling out this form, you agree to be added to Washington Park East Neighborhood Association's email list.
*
Agree
Membership Type
*
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Household Membership
$
20.00
65+ Household Membership
$
10.00
Additional Contribution
Optional
$
10.00
Quantity
0
1
2
3
4
5
6
7
8
9
10
Payment Methods
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Please click one of the PayPal options to complete payment and
submit
the form.
Submit
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