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Mail-In Membership Application
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Please
complete this application in print
and mail it to Northeast Council of W.I.C.C.A., Post Office Box 357, North Greece,
NY 14515. Our Member Services Coordinator will contact you
regarding the status of your application after it has been
reviewed. Note: Use your browser's functions to
print form and to return to site. Thank You!
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Member
Information
Last Name
______________________
First Name _______________________
Craft / Community Name _____________________________________________ |
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Business /
Organization
_______________________________________ |
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Address 1
________________________________________ Apt.______ |
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Address 2
_________________________________________________ |
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Your City
_____________________________ State
_____ Zip _______ |
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Date
of Birth ______________________ (Note That This
Information Is Required) |
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Phone Number (
____ ) _____________ E-Mail Address __________________
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Member Level
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Payment Method
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o $10.00 -
Individual (Tier 1)
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o
I am enclosing a check for payment
in the amount of $_______.
o I would like to make arrangements
to pay by cash . |
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o $10.00 -
Individual (Tier 2)
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o $15.00 -
Group / Coven |
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$15.00 - Family |
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o
$25.00 - Business |
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Privacy and Security
Personal
and financial Information
secured through this application is used for the
sole purpose of processing your membership and maintaining member
records. Your
privacy will always be respected, and financial information
secure.
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Terms of Service
By submitting
this application, I acknowledge and agree to the following
terms of service regarding membership to Northeast Council
of W.I.C.C.A.: |
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1.
I
acknowledge that I am at least 18 years of age and
agree to submit documentation
if
requested.
2. I understand
that
Membership Dues and / or Contributions are not
yet tax deductible.
3. I also understand
that Memberships are renewable on an annual basis
and are billed
and payable to Northeast Council of
W.I.C.C.A..
4. I agree to uphold
the by-laws of this organization and act in accordance
with the
principles stated therein.
5. It is also
agreed that as a member(s) of this
Council that community-based
volunteering of 10 hours per year
is required.
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__________________________________
___________________
Applicant's Signature
Date
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