I wish to join the Parrish Civic Association.
Here are my dues for 2010.
January 1, 2010 – December 31, 2010
(please print)

Name: ___________________________________________________________

Address: __________________________________________________________

__________________________________________________________

Phone No.: ________________________________________________________

Email Address: _____________________________________________________

   (above information is for PCA use only, we do not give out or sell to outside parties)

Please check one:   ______ New Member             ______Renewal

Membership Levels

______  Basic Membership: $15

______  Booster Membership: $25

______  Sponsor Membership: $50

______  Community Patron Membership: $100.00 or more

______ Corporate Membership: $500.00 or more

Amount Enclosed $_________________

I wish to volunteer for the following (please check):

THIS IS YOUR CHANCE TO SUPPORT PARRISH  !

MAIL TO: