Laurel Highland’s Historical Village

APPLICATION FOR MEMBERS

A Note from the Founding Board of Directors

Recording keeping is vital to every organization; any information disclosed to LHHV will be kept private & used solely for the organization statistic purposes.

The purpose of this application is to enable the Laurel Highland’s Historical Village to keep on record those members who have joined, for the purpose of fulfilling those laws set forth by the federal, State, and local governments. All information will be used only for the purpose of Laurel Highland’s Historical Village.

PERSONAL INFORMATION

Name ________________________________________________________________________________

Address______________________________________________________________________________

Telephone  Res. _____/____________________Cell__/__________________Bus. _____/____________

Age : Circle one:  Youth member  18 – 30       31– 41      42 – 52          53 – 60      60 or older

E-mail address ________________________________________________________________________

Please list your Skill set and Knowledge base.  Music Dance, Carpenter etc. 

_______________________________________________________________________________________________

                                                                    ETHNIC AFFLILIATION(s)

Of what background(s) are you affiliated? I.e. Polish, French etc. _______________________________________

What committee(s) could you help with?_______________________________________________________

Signature ________________________________________________. verifies your desire to become a member of LHHV, and you agree to the laws set forth in our by-laws. You also allow LHHV to use your  information for the sole purpose of LHHV activities.

Date__________________