Membership Application

TOWNS COUNTY CIVIC ASSOCIATION

Post Office Box 455, Hiawassee, GA 30546-0455

Website: www.townscountycivicassociation.com                                                              Email: tcca455@gmail.com

Date: ____________________________________

Name(s) ________________________________________________________________________     __________________________________________________________________________

Residency: Full-time ___ Part-time ___ (*if part-time please complete both address sections)

Towns County mailing address: _________________________________________________________________  City: _____________________________Zip Code:____________

Email: _____________________________________________________________________                                     _______________________________________________________________

Phone Numbers: Home (________) _______________________________________                                       Cell (________) ________________________________________________

*Part-time Residents’ Home Address:

______________________________________________________________________________________________________________________________________________________________

Dues: $25.00/year for both Individuals and Families, July 1 to June 30 of each year.    The enclosed payment is for which year(s): ______________________

This section to be completed by Association Officer or Director

Paid by: Check # ________ Cash $_________ If cash was a receipt issued ________

Date received: ____________20____ Date deposited: ___________20____

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