Broadview Community Council Membership Form
Name(s)________________________________________
____________________________________________
Address ________________________________________
City/St/Zip ______________________________________
Phone (work/home)____________________ E-mail ______________________________________
Newsletter Preference: Paper ______ E-mail _________
Membership: _____$5 Senior _____$10 Household ______$75 Business
Note: Membership is for the current calendar year and cannot be prorated.
Renewal ______ New Member ______
Additional Donation _____$25 Benefactor _____$50 Patron
Print and mail this form with your check to:
Broadview Community Council
P. O. Box 77761
Seattle, WA 98177