KINGS PARK CIVIC ASSOCIATION MEMBERSHIP APPLICATION

Please make checks payable to:  KPCA                   Mail to:  KPCA, P.O. Box 165, Kings Park, NY 11754

Dues:      $25 Family (two voting memberships);    or $15 Single

Names (s):_________________________________________________________________________________________________

Street Address: ___________________________________________________________________________________________

Phone #: ____________________________________


Email:________________________________________________________

What would you consider the most important issues facing our community today?

1.__________________________________________________________________________________________________________

2.__________________________________________________________________________________________________________

3.__________________________________________________________________________________________________________

Print the membership form below and mail with payment to:

Kings Park Civic Association

P.O. Box 165

Kings Park, NY 11754

Kings Park Civic Association