Old Farm Neighborhood Association

Membership Application

How Can I Serve My Community and

Protect One of My Greatest Investments… My Home?

Get Involved!!

Check # ________

Deposited _______

Recorded ________

Old Farm Neighborhood Association

2013 Membership Application

DUES: Membership is $12 a year per adult (18 or older) in household. Our year is January through December.

Member Name (A): ____________________________________________

(B): ____________________________________________

(C): ____________________________________________

Address: _____________________________________________________

Home Phone number: __________________________________________

* Cell Phone number: (A) __________ (B) __________ (C)__________

Email (A): ___________________________________________________

(B): ___________________________________________________

(C): ___________________________________________________

Amount paid: $________________________________________________

Date paid: _____________________________________________________

Please PRINT to fill out this form, make check or money order payable to

Old Farm Neighborhood Association (OFNA) and send to

OR

contact:

Carolyn Young

329 Rippling Stream Road

Durham, NC 27704

471-1043

cyoung63@nc.rr.com

*

IN CASE OF EMERGENCY ONLY! NOT FOR GENERAL PUBLIC!