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:

    Email Address (Adult 1)

    Show Email in Directory?

    YesNoNA

    Cell Phone (Adult 1):

    Do you text?

    YesNoNA

    ADULT 2

    FIRST NAME and LAST NAME:

    Email Address (Adult 2)

    Show Email in Directory?

    YesNoNA

    Cell Phone (Adult 2)

    Do you text?

    YesNoNA

    ADULT 3

    FIRST NAME and LAST NAME:

    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:

    Adult Christmas Party HostAdult Christmas Party ParticipantBook clubCrafting/card makingDining Out GroupGourmet ClubNeedle craft groupNeighborthood garage saleRunningWalk for exerciseWidows/widowers

    Child Care:

    Babysitting (by adults)Babysitting Co-opChildrens Play Group

    Games:

    Bridge (couples)Bridge (ladies)Bunco (ladies)Bunco sub (ladies)CanastaDominosMonday Night FootballPinochle card gamePokeno (ladies)Pokeno sub (ladies)Poker club (men)Poker-Penny Ante (men)

    Leadership:

    Block CaptainBoard member/officerCrime Watch CoordinatorMarketing/advertising assistantNewsletter editorPhotographerSocial Media CoordinatorYard-of-Month CoordinatorZone Director

    Services:

    Easter Bunny VolunteerHouse Sitting (by adults)Lawn Mowing (by adults)Petsitting (by adults)

    Comments