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N.B.C.C. Members Application & Info. Form
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Email
*
Your email
Today's Date:
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Your answer
Full Legal Name
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Your answer
Full Address (House or Building #, Street, City/Borough, and Zip Code):
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Your answer
Phone number(s):
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Your answer
Best Email Address(es) to reach you:
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Your answer
Birthday:
Your answer
Have you paid any Membership Dues, and/or are you willing and able to pay reasonable minimal annual Membership Dues?
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Your answer
Sponsored for Membership by and/or how did you find out about us:
Your answer
Please select the Committee you are most interested in:
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Environment, Land Use, and Private & Public Services Comittee
Public Safety & police Relations Committee
Recreation, Parks, & Youth Affairs Committee
Social, Benevolence, & Membership Committee
Special Events. Programming, & Fundraising Commiteee
Required
Please select a 2nd Committee you are interested in:
*
Environment, Land Use, and Private & Public Services Comittee
Public Safety & police Relations Committee
Recreation, Parks, & Youth Affairs Committee
Social, Benevolence, & Membership Committee
Special Events. Programming, & Fundraising Commiteee
Required
Are there any other of the committees listed above that you are interested in (if so which ones)?:
Your answer
Might you be interested at some time in the future serving as a chairperson of any of the above
committees, If so which one(s)?:
Your answer
Are you a new member OR how long have you been a member of our organization?
(Has your address, phone #, or e-mail changed since you first joined)?:
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Your answer
Have you ever in the past participated in or with our organizations' block parties, youth
baseball teams, creative workshops, dinner dances, holiday parties, protests, clean-ups,
fundraisers, rallies, or any other events/projects, if so which one(s):?:
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Your answer
Have you ever previously held any offices or titles within our organization? (If so, which one(s)?):
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Your answer
Will you pledge to bring and sign up at least one new member this year:
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Your answer
Do you have any young children, teenagers, or young adults in your household? (If so what age(s)):
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Your answer
Do you belong to any other civic, community, political, or social organizations? If so, what are
they/which ones do you belong to (please name as many as possible, thanks) and do you hold a title or position in any of these organizations?::
*
Your answer
Do you have any special skills or talents, special areas of interests, or any areas of
expertise?:
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Your answer
What is your occupation?:
Your answer
WHAT ARE THE TOP 5 ISSUES FACING
NEW BRIGHTON & THE NORTH SHORE OF S.I.?
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Your answer
WHAT ARE 3 OTHER ISSUES THAT ARE IMPORTANT TO YOU ?
Your answer
A copy of your responses will be emailed to the address you provided.
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