West Side Neighborhood Association Membership Application

Contact Information  (please print)

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First Name                                           MI                                               Last Name

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Mailing Address                                  City                                        State              Zip

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Home Phone                                                      Work Phone

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Email                                                                   Fax

For persons who are residents and/or property owners.
______I live on the west side

______I own property on the west side.

______I live in rental property on the west side.

If yes to any of the above, please give address(es). (If different or in addition to the above address.)

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____________________________________________________________________

____________________________________________________________________

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Businesses and Professionals
_______I work on the west side.

_______I own a business and property on the west side.

_______I conduct a business on the west side in property I lease.

If yes to any of the above, please fill in below.

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Name of Business

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Address

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Phone Number

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Title

Yes, I want to be a member of the WSNA and help in its efforts to improve the West Side.

If you are interested in further involvement please feel free to join any of the following committees.
(Note: members are not required to join a committee.)

_________Quality of Life           _________Community Relations                  

________Finance                       _________Planning

Membership:

_______  Individual          $12.00

_______Businesses with 25 or fewer employees    $25.00

_______Businesses with more than 25 employees    $50.00

_______Enclosed is my membership investment check and application.

Mail to:

West Side Neighborhood Association
600 Florida Street
Charleston, WV 25302
304-720-6200