Kissena Park Civic Association
Application for Membership
Your Name(s): _____________________________________________
Address ____________________________________________________
Zip Code ____________
Telephone number _______________________________________
FAX number ___________________________________________
E-mail address __________________________________________
Pay $15 for family membership.
Pay $10 for senior citizen membership.
Voluntary contribution
Total enclosed ---------------------------------------- $_____
Please mail this application to:
Kissena Park Civic Association, Inc.
P.O. Box 580423 Flushing NY
11358-0423
* Yearly dues are payable by January 1st of each year. New members who join after September 1st are paid through the following year.