Membership Application for Barrett Civic League

Barrett Civic League Membership Enrollment Form

Please fill out the form below to become a member of the Barrett Civic League. Choose your membership level and provide your details.
Select Membership Level*

Individual Membership – $75/yearFamily Membership – $100/year (2 adults)Senior Membership – $50/yearOrganizational Membership – $350/year
Organization name
Name (Delegate 1)*

TItleFirst NameMiddle NameLast NameSuffix
Birthday (Delegate 1)*

MonthDayYear
Date
Phone Number (Delegate 1)*
Please enter a valid phone number.Format: (000) 000-0000.
Email Address (Delegate 1)*
example@example.com
Name (Delegate 2)*

TItleFirst NameMiddle NameLast NameSuffix
Birthday (Delegate 2)*

MonthDayYear
Date
Phone Number ((Delegate 2)*
Please enter a valid phone number.Format: (000) 000-0000.
Email Address (Delegate 2)*
example@example.com
Name*

TItleFirst NameMiddle NameLast NameSuffix
Birthday*

MonthDayYear
Date
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email Address*
example@example.com
Preferred Method of Communication

EmailText Message
Name (Member 2)*

TItleFirst NameMiddle NameLast NameSuffix
Birthday (Member 2)*

MonthDayYear
Date
Phone Number (Member 2)*
Please enter a valid phone number.Format: (000) 000-0000.
Email Address (Member 2)*
example@example.com
Mailing Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Membership Dues Payment*
prevnext( X )
Individual Membership
$75.00 Quantity



Senior Membership

$50.00 Quantity



Family Membership
$100.00 Quantity



Organizational Membership
$350.00 Quantity



Total

$0.00
Should be Empty:

Barrett Civic League Membership Enrollment Form