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SOUTH MERRICK COMMUNITY CIVIC ASSOCIATION MEMBERSHIP APPLICATION  

Name (s) _____________________________________________________________  

Address ______________________________________________________________  

______________________________________________________________  

Telephone(s) Home_____________________Cell_____________________________

E-mail address _________________________________________________________

Thoughts, ideas or to volunteer ____________________________________________

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Please circle the membership you prefer and send a check, made out to "SMCCA," for the indicated amount to SMCCA, PO Box 381, Merrick, NY 11566.  

1-year, $25                                2-years, $45                         3-years, $60