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MEMBERSHIP FORM
SPOUSE’S NAME (If also applying for membership):_________________________________________________________________
ADDRESS__________________________________________________________________________________________________
Street City/State Zip Code
TELEPHONE NO:________________________________________CELL:_______________________________________________
E-MAIL ADDRESS:___________________________________________________________________________________________
WHO MAY WE THANK FOR REFERRING YOU TO THE STNinJC:_____________________________________________________
MEMBERSHIP CRITERION: Yes, I/We are dedicated & support the Mission of the Organization: Check To Confirm: _____________
MEMBERSHIP DUES: $10 Per Person for one full year of membership OR If $10 is beyond your means, any contribution amount will
qualify for membership.
MEMBERSHIP AMOUNT PAID: (Indicate below the total amount of membership dues being paid and the total number of persons).
$10 per person: $_________________ (1) ____________ or (2) ____________
Total Amount Check No. of Persons
CONTRIBUTION AMOUNT MADE: (In addition to Membership Payment, contributions are always welcome and are tax deductible).
If you also wish to make a contribution at this time, please indicate the amount: $ _________.
TOTAL AMOUNT PAID : (Dues & Contribution, if any): $_______; Check Payment Method: Cash ______; or Check_____ & No. ______
_____________________________________________________________ ________________________________________
Signature Date
_____________________________________________________________ ________________________________________
Signature (Spouse if also applying) Date
SPOUSE’S NAME (If also applying for membership):_________________________________________________________________
ADDRESS__________________________________________________________________________________________________
Street City/State Zip Code
TELEPHONE NO:________________________________________CELL:_______________________________________________
E-MAIL ADDRESS:___________________________________________________________________________________________
WHO MAY WE THANK FOR REFERRING YOU TO THE STNinJC:_____________________________________________________
MEMBERSHIP CRITERION: Yes, I/We are dedicated & support the Mission of the Organization: Check To Confirm: _____________
MEMBERSHIP DUES: $10 Per Person for one full year of membership OR If $10 is beyond your means, any contribution amount will
qualify for membership.
MEMBERSHIP AMOUNT PAID: (Indicate below the total amount of membership dues being paid and the total number of persons).
$10 per person: $_________________ (1) ____________ or (2) ____________
Total Amount Check No. of Persons
CONTRIBUTION AMOUNT MADE: (In addition to Membership Payment, contributions are always welcome and are tax deductible).
If you also wish to make a contribution at this time, please indicate the amount: $ _________.
TOTAL AMOUNT PAID : (Dues & Contribution, if any): $_______; Check Payment Method: Cash ______; or Check_____ & No. ______
_____________________________________________________________ ________________________________________
Signature Date
_____________________________________________________________ ________________________________________
Signature (Spouse if also applying) Date
Membership Dues are $10 and extends for 12 Months. Sole Criterion is being committed to the mission of the Organization. This Form may be printed off your computer and submitted by mail. |
| Make Check payable to: STNinJC Mail Check and Membership Form To: Kristin M. Williams, Secretary STNinJC 2121 Powell Drive Clayton, North Carolina 27520 |
MEMBERSHIP FORM
| SERVE THE NEED IN JOHNSTON COUNTY, INC. What we do by ourselves matters; What we do together really makes the difference. When We Give; We Get Back. |
| SERVE THE NEED IN JOHNSTON COUNTY Inc. Post Office Box 1016 Clayton, North Carolina 27528-1016 919-550-0614 Email: info@servethe needinjc.com |
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