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Central Northside Neighborhood Council 1310 Arch Street Pittsburgh, PA 15212 Phone: 412-231-7742* Fax: 412-322-3386 Email: info@cnnc-pgh.org www.cnnc-pgh.org

2009 CNNC Membership Registration Form

Dues Run From January 2009-December 2009

Please print legibly.

N a m e : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

A d d r e s s : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

P h o n e ( H o m e ) : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ( O t h e r ) : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Email:

_____________________________________________________________

D o y o u w a n t t o r e c e i v e t h e N e w s l e t t e r v i a e m a i l ? Y _ _ _

N

___

Signature: Date: __________________________________ __________ If you do not reside in the central North Side please list properties you own on the Central

Northside:

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

(Please continue

listing on back)

$5 $3 (seniors 60+) for my dues for 2009. Enclosed is _____ _____ If your organization/business would like to be a member, dues are ____$25 Please name the delegate for your organization:_________________________ Enclosed is an additional tax-deductible donation of

$20

__________

$40

_____

$60

_ _ _ _ _ _ _ _ _ _ _

$100

________

Other_________

I am interested in participating in the following committees of CNNC: ____________Youth ____________Communications (newsletter, web site management, announcements) ____________Development ( Business District and Housing) ____________Membership (outreach to the community, event planning) ____________Public Safety ____________Litter and Beautification ____________Strategic Planning (evaluating neighborhood needs and planning

strategies to meet identified needs)

Date: ___________________ Amount Paid: _____________ Check___________________ Cash_____________________ Received by____________________________

Send this form or drop it off at the CNNC office with your dues (Check or Cash) Make check payable to CNNC: CNNC Membership, 1310 Arch Street, Pittsburgh, PA 15212

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