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Packer Park Civic Association
 
Print Membership Form in Acrobat Format
Print Membership Form in Acrobat Format
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MEMBERSHIP APPLICATION

  (PLEASE PRINT LEGIBLY) 

First Name__________________ Last Name_____________________________
Street Address_____________________________________________________
Philadelphia, PA 19145
Phone (____) ____--_______________
Email address______________________________________________________
Please list all additional members of your immediate family when membership is for a household.
1.__________________________________________________________________
2.__________________________________________________________________
3.__________________________________________________________________
4.__________________________________________________________________
5.__________________________________________________________________

           CAR STICKERS ____________ VISITOR PASSES____________

 

# Make / Model of Car   Registration   State
1. ___________________   ___________________   __________
2. ___________________   ___________________   __________
3. ___________________   ___________________   __________
4. ___________________   ___________________   __________
5. ___________________   ___________________   __________

$12 dues for one year or $20 for two years for all members of a household.
One vote per household.
Dues are on a calendar year basis.

Bring the completed form with payment to a meeting, or send it to:
PPCA, 3320 S. 20th Street, Philadelphia, PA 19145