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Grand Mound Rochester Park Association
PO Box 1266
Rochester, WA 98579
(360) 273-0398

MEMBERSHIP APPLICATION
MEMBERSHIP YEAR 2006
June 1, 2006 - May 31, 2007 

Name___________________________________________________________

Mailing Address __________________________________________________

 Phone __________________             Email ______________________________

 q    Check if you do not want your name(s) included on membership lists appearing in
our printed materials.  Your personal information will not be shared.

 Signature(s) ________________________ Date _______________________

 Membership Levels
Grand Mound Rochester Park Association is a not-for-profit 501(c)3 charitable organization.  Your membership donation may be tax deductible.
 

 ____STUDENT................... $5/YR.                                     ________ BUSINESS MEMBER............ $100/YR.

_____INDIVIDUAL............... $10/YR.                                   ________ BENEFACTOR...................... $250/YR.

                          _____FAMILY.......................... $25/YR.                                 ________ OTHER............................. (INSERT YOUR AMOUNT)

q   CHECK HERE if your employer has a matching gift program, and attach matching gift form

q   I wish to apply for a dues waiver and contribute time instead  

I/WE WOULD LIKE TO VOLUNTEER

_____Computers _____Office Work   _____Landscaping  _____Clean-up
   _____Painting          _____Carpentry        _____Fund raising

_____Photography
_____Board Member  _____Other_________________________

Thank You!


If you desire additional information about the Grand Mound Rochester Park Association or the Rochester Community Park, e-mail matslewis@msn.com

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