THALIA CIVIC LEAGUE, INC. AND NEIGHBORHOOD WATCH
2006/07 MEMBERSHIP APPLICATION

Name: ____________________________________________________________

Spouse’s First Name: ________________________________________________

Street Address: ____________________________________________________ 

Virginia Beach, VA 23452

Home Phone: _______________________ Work Phone: _____________________

E-mail Address: ______________________________________________________

Number of People in your Household: ___________________

PLEASE CHECK as applicable:

Sign my household up as a member of the Thalia Civic League, Inc.

Sign my household up as a member of the Thalia Neighborhood Watch Program.

I need more information on the Neighborhood Watch Program.

I hereby apply for membership in the Thalia Civic League, Inc. and Thalia Neighborhood Watch Program.

I want to make a donation to the Thalia Civic League, Inc. in the amount of  $ ________________.

Signature ______________________________________

NOTE:

Please print, complete and mail this form to:

Thalia Civic League, Inc.
c/o Reginald S. Early, Treasurer
748 Pine Tree Drive

Virginia Beach, VA 23452