Dividing Creek Association
 

Membership Application

Form
 

If you wish to join the Dividing Creek Association please fill out the form below and mail it to the association at the address below:

        Dividing Creek Association
        P.O. Box 1234
        Kilmarnock, VA 22482

Membership Form

2010 Dues: $30.00 per family – after June 1st dues become $35.00 per family.
                        $15.00 for singles - after June 11st dues become $17.50 per person.
Guest Fees for the Annual Picnic and Oyster Roast: $20.00 per guest

$5.00 of your dues is Tax Deductable and goes toward the Hughlett Point Nature
Preserve, Northumberland Preservation Inc's Shiloh School project and our own Dividing Creek Association, Citizen Volunteer Water Quality Monitoring Group.

Please mail your dues and this form to the following address:

Dividing Creek Association

P.O. Box 1234

Kilmarnock, VA 22482

Name:  __________________________________________________________

Mailing Address:  __________________________________________________

Alternate Mailing Address ___________________________________________

Telephone Number: _________________________________________________

Alternate Telephone Number:  ________________________________________

Email Address (VERY IMPORTANT): ________________________________________

Alternate Email Address:  ___________________________________________

  YES       NO        I am interested in serving as a

Board Member.

Please contact me.