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