KPWCA Membership Form
Please complete this form even if you have been a member in the past. All information provided will be entered into the Membership Database. Membership and entry into the KPWCA directory minimally require payment of $20 in annual dues which can be paid by:

1) Check, payable to KPWCA and either mailed to KPWCA, P.O. BOX 7114, Fairfax Station, VA 22039-7114 or given to your Block Captain or

2) Cash given to your Block Captain or

3) Paid on-line via PayPal from the Kings Park West Civic Association website here http://www.kpwca.org

http://www.kpwca.org
Block #
Please enter your block number if you know it, or leave blank if you don't.
Your answer
Last Name
Enter you or your family's last name only. Use mixed case. e.g. Doe
Your answer
First Name (s)
Enter your first name, the first name of your spouse and the first names of children (if you like). e.g. John & Mary, Dave, Meg
Your answer
House Number
Enter just your house number. e.g. 99999
Your answer
Street
Enter just your street name abbreviating the street type e.g. Commonwealth Blvd.
Your answer
Phone Number
Enter your entire primary phone number without punctuation. (e.g. 7037641234) You may choose to have it published, or not, below.
Your answer
Phone Number 2
Optional - Enter your entire secondary phone number without punctuation (e.g. 7037644321)You may choose to have phone numbers published, or not, below.
Your answer
Email Address
Enter your email address. (e.g. John.Doe@kpwca.org) You may choose to have it published, or not, below.
Your answer
Email Address 2
Optional - Enter your secondary email address (e.g. JaneDoe@kpwca.org) You may choose to have email addresses published, or not, below.
Your answer
Do you want your name(s) published in the Kings Park West directory?
Do you want your street address published in the Kings Park West directory?
Do you want your phone number published in the Kings Park West directory?
Do you want your email address published in the Kings Park West directory?
Would you like to make an additional donation?
Categories include: Volunteer Fire Department, KPWCA Boy Scout Units, Robinson HS Drug/Alcohol Free Grad Party, TJHSST Drug/Alcohol Free Grad Party, Herald Newsletter, Unrestricted Community Use, Halloween Festival, Easter Egg Hunt, College Scholarships, Parks & Lake and Common Area Maintenance
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