Membership Form

If you prefer to view, print and mail a hardcopy of the WNA membership form, CLICK HERE FOR HARDCOPY, otherwise please fill out the online WNA membership form below.

ONLINE MEMBERSHIP FORM

    Street Address (required)

    Primary Phone # (xxx-xxx-xxxx)

    Emergency Phone # (xxx-xxx-xxxx)

    ADULTS IN HOUSEHOLD

    ADULT 1 (First and Last Names Required)

    FIRST NAME and LAST NAME:

    Enter Email Address (Adult 1)

    Show Email in Directory?

    YesNoNA

    Cell Phone (Adult 1):

    Do you text?

    YesNoNA

    ADULT 2

    FIRST NAME and LAST NAME:

    Enter Email Address (Adult 2)

    Show Email in Directory?

    YesNoNA

    Cell Phone (Adult 2)

    Do you text?

    YesNoNA

    ADULT 3

    FIRST NAME and LAST NAME:

    Enter Email Address (Adult 3)

    Show Email in Directory?

    YesNoNA

    Cell Phone (Adult 3)

    Do you text?

    YesNoNA

    OTHER ADULTS IN HOUSEHOLD (separate multiple names with a comma)

    Names of Other Adults in Household:

    CHILDREN IN THE HOUSEHOLD (all fields are optional)

    CHILD 1 Name:

    Birthdate (MM/YY):

    Services offered by Child 1:

    BabysittingLawn MowingHouse SittingPet SittingMom's Helper

    CHILD 2 Name:

    Birthdate (MM/YY):

    Services offered by Child 2:

    BabysittingLawn MowingHouse SittingPet SittingMom's Helper

    CHILD 3 Name:

    Birthdate (MM/YY):

    Services offered by Child 3:

    BabysittingLawn MowingHouse SittingPet SittingMom's Helper

    Names and Birthdates of additional children (if applicable)

    Format: Name1 (MM/YY), Name 2 (MM/YY)

    INTERESTS AND VOLUNTEER OPPORTUNITIES

    Activities/Groups:

    Ad Sales AssistantAdult Christmas Party HostAdult Christmas Party ParticipantBabysitting (by Adults)Babysitting Co-opBlock CaptainBoard Member/Officer*Book ClubBridge (Couples)Bridge (Ladies)Bunco (Ladies)Bunco Substitute (Ladies)CanastaCrafting/Card MakingCrime Watch CoordinatorCrime Watch VolunteerDining Out GroupDominosEaster Bunny VolunteerGourmet Club ParticipantGourmet Club SubstituteHouse Sitting (by Adults)Lawn Mowing (by Adults)Marketing/Advertising AssistantMonday Night FootballNeedle Craft GroupNeighborthood Garage SaleNewsletter EditorNewsletter PhotographerPet Sitting (by Adults)Pinochle Card GamePokeno (Ladies)Pokeno Sub (Ladies)Poker - Penny Ante (Men)Poker Club (Men)RunningSocial Media CoordinatorWalk for ExerciseWidows/WidowersYard of the Month CoordinatorZone Director*

    Comments