SELDEN CIVIC ASSOCIATION, Inc.

P.O. Box 521

Selden, Long Island, New York 11784

APPLICATION FOR MEMBERSHIP

DATE________________________________PHONE___________________________________________________

NAME__________________________________________________________________________________________

ADDRESS______________________________________________________________________________________

TOWN____________________________________________________ZIP CODE_____________________________

If this application is accepted, I agree to be governed in all meetings of the Association by its Constitution

and By-Laws.

E-MAIL ________________________________________________________________________________________

REMARKS ______________________________________________________________________________________

_______________________________________________________________________________________________

MEMBERSHIP Donation $10.00 per family or per person...

Please include check with application

Our e-mail address is seldencivic@optonline.net

Our web-site address is www.seldencivic.org

If you would like to contact us please send us an e-mail we will reply to your need or concern or even an idea.

 Thank you for your support.