West Lane Place Civic Association

WLPCA Membership/Renewal Application

Oct 27, 2005

WEST LANE PLACE CIVIC ASSOCIATION
Membership/Renewal Application
(July 1, 2005 ?– June 30, 2006)
www.neighborhoodlink.com/houston/wlcpca

$25 dues, individual membership
$15 dues, senior citizen (65+) discount

____________Renewal


____________New Member (s)

Name(s) to be listed in roster__________

WLP Street address______________________


Mailing address, if different___________

Phone number____________________________

e-mail__________________________________

__________Do NOT list my PHONE in WLPCA
Roster

__________Do NOT list ANY of my
information in roster

__________I enclose an additional contribution of $_________

__________I am interested in contributing time or in-kind services ?– call me!

Make checks payable to West Lane Place Civic Association

Mail or deliver application and payment to Marj Gordon, 3334 Midlane, Houston, TX 77027