Northwest Orange County Improvement Association
P.O. Box 786 - 4253 Ponkan Road Zellwood, Florida 32798 Phone: (407) 886-0014 - Fax: (407) 886-0001 Email: contact@nocia68.com |
| Name:_________________________________________________________________ Street Address:__________________________________________________________ Mailing Address_________________________________________________________ City:___________________________State:_______________ Zip code:____________ Phone: ( )______________ Cell: ( )______________ Fax: ( )_______________ Date of Birth:_______________________________________________________ Spouses Date of Birth:________________________________________________ (Month/Day/Year-Name Month/Day/Year-Name) Anniversary: _____________________ Email Address: _________________________ (Month/Day/Year) Membership: (Check one) New Member ____ Renewal:____ Membership fee per person: $ 20.00 per year -1 vote Please check the areas that you or your spouse would be interested in participating: Kitchen Committee___ Entertainment Committee____ Corn Festival ____ Program Planner___ Board member____ |
List of other things that you would like to see N.O.C.I.A do, including activities: Others:____________________________________________________________ _________________________________________________________________ Members signature:________________________________________ Spouses signature:_________________________________________ ---------------------------------------------------------------------------------------------- |
For Office Personnel Only:
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| Date Approved:_______________________________________________________ Amount Paid:_________________________________________________________ Card Number Issued:___________________________________________________ Spouse Card Number Issued:_____________________________________________ |