College Park Community Organization for Concerned Citizens

MEMBERSHIP ENROLLMENT

2000-2001

COLLEGE PARK COMMUNITY ORGANIZATION FOR
CONCERNED CITIZENS


MEMBER DUES: $12.00 PER HOUSEHOLD, BUSINESS,
SCHOOL,CHURCH (SENIORS EXCLUDED)
ASSOCIATE MEMBER: $6.00 PER HOUSEHOLD, BUSINESS, SCHOOL, CHURCH

Complete and mail in this form with your check or money order made payable to this organization:
Gertrude Brooks, Treasurer/ C/O Membership Fees
7410 W. Outer Dr.
Detroit, Michigan 48235

NAME______________________________________________

ADDRESS______________________________________

CITY_______________ ZIP___________

HOME PHONE_________________WORK PHONE_____________

MEMBERSHIP TYPE: HOUSEHOLD * BUSINESS * CHURCH
* OTHER
(Please circle appropriate membership type)

DATE RECEIVED: ____/____/____ AMT. RECD. _______