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MEMBERSHIP RENEWAL FORM
FIRST NAME: _____________________________________ LAST NAME: ___________________________________
SPOUSE’S NAME (If also applying for membership): _________________________________________________________
ADDRESS: _____________________________________________________________________________________________
TELEPHONE NO:________________________________________CELL: __________________________________________
E-MAIL ADDRESS: ______________________________________________________________________________________
RENEWAL AMOUNT PAID: Indicate below the total amount being paid for renewing membership and the total number of persons.
$10 per person for one full year of membership from date of last enrollment payment.
$_________________ (1) ______ or (2) _______
Total Amount Check Number of Persons
CONTRIBUTION AMOUNT MADE: In addition to renewal payment, contributions are always welcome and are tax deductible.
If you also wish to make a contribution, please indicate the amount: $ _____________.
TOTAL AMOUNT PAID: (Dues + Contribution): $________ ; Method Paid: Cash_____; Check_____ & Check No _____
DATE OF SUBMISSION: ____________________________ SIGNATURE: _______________________________________
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NOTE: In the unfortunate event you do not wish to renew your membership in the STNinJC, let us know and we will remove your name from the list and
you will not receive any more renewal notices. We also invite your comments regarding the reasons for your decision.
If so, please Check: I do not wish to renew my membership in the STNinJC: _____ and sign and date below.
NAME: _______________________________________________________ DATE: ____________________________________
COMMENTS: _______________________________________________________________________________________________________
FIRST NAME: _____________________________________ LAST NAME: ___________________________________
SPOUSE’S NAME (If also applying for membership): _________________________________________________________
ADDRESS: _____________________________________________________________________________________________
TELEPHONE NO:________________________________________CELL: __________________________________________
E-MAIL ADDRESS: ______________________________________________________________________________________
RENEWAL AMOUNT PAID: Indicate below the total amount being paid for renewing membership and the total number of persons.
$10 per person for one full year of membership from date of last enrollment payment.
$_________________ (1) ______ or (2) _______
Total Amount Check Number of Persons
CONTRIBUTION AMOUNT MADE: In addition to renewal payment, contributions are always welcome and are tax deductible.
If you also wish to make a contribution, please indicate the amount: $ _____________.
TOTAL AMOUNT PAID: (Dues + Contribution): $________ ; Method Paid: Cash_____; Check_____ & Check No _____
DATE OF SUBMISSION: ____________________________ SIGNATURE: _______________________________________
*******************************************************************************************************************************************************************
NOTE: In the unfortunate event you do not wish to renew your membership in the STNinJC, let us know and we will remove your name from the list and
you will not receive any more renewal notices. We also invite your comments regarding the reasons for your decision.
If so, please Check: I do not wish to renew my membership in the STNinJC: _____ and sign and date below.
NAME: _______________________________________________________ DATE: ____________________________________
COMMENTS: _______________________________________________________________________________________________________
We value you as a member of the Organization and hope that you will continue to be a part of a community of concerned citizens committed to helping residents of Johnston County improve their quality of life. The schedule for renewing membership is one year from the last payment date which assures twelve full months of membership with each $10 renewal payment. This Form may be printed off your computer and submitted by mail. |
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| Make Check Payable To: STNinJC Mail Check and Renewal FormTo: Kristin M. Williams, Secretary STNinJC 2121 Powell Drive Clayton, North Carolina 27520 |
MEMBERSHIP RENEWAL 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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