Membership Form

To become a member, complete this form and mail it to: Maple Leaf Community Council, PO Box 75595, Seattle, WA 98125

Name______________________________________________

Address__________________________________Zip_______

Home Phone_______________________ Work Phone_______________________

Membership:

___ Individual/Family - $15 ___ Senior - $2 minimum ___ Benefactor - $30 ___ Patron - $60 ___ Business - $50

Circle Issues you would like to be involved in:

Transportation and Land Use Garden Club Neighborhood Planning Board Member

Space Jam Scholarship Foundation Parks Newsletter Graffiti Control

Noise Control Aircraft Noise Dues/Membership Block Watch Other___________