Membership Application

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PLEASE PRINT ALL INFORMATION.

ALL APPLICANTS ARE ASKED TO FILL OUT THE TOP PORTION OF THIS FORM.

NAME^*: _______________________________________________________

ADDRESS: _____________________________________________________

CITY, STATE, ZIP: _______________________________________________

TELEPHONE NUMBER: ____________________________________________

EMAIL ADDRESS: ______________________________________________

_____ INDIVIDUAL MEMBERSHIP AT $25

_____ INDIVIDUAL SUPPORTER MEMBERSHIP AT $25

^*One name per Individual or Supporter membership, please

Individual and Supporter applicants may stop here. You do not need to fill out the rest of this form.

ADDITIONAL INFORMATION FOR GROUP MEMBERSHIPS ONLY:
We, the duly organized members of _________________________________
on __________________, 20_____ resolve to join Tammany Together, Inc.
Our current membership is __________ (households/persons).
A check for $ ____________ ($1 per member with a minimum of $25 and a maximum of $200) is enclosed.
Primary Delegate ____________________________		Email ___________________
1^st Alternate Delegate ________________________		Email ___________________
2^nd Alternate Delegate ________________________		Email ___________________
All delegates are residents of St. Tammany Parish and are at least eighteen (18) years of age. Our organization meets all the requirements of Group Membership including being a resident-controlled homeowner or civic association.
_________________________	______________________		________________________
Authorized Signature	Title		Date
_________________________________________________			________________________
Name (Printed)			Telephone Number
Website Address: _______________________________________________________
May we link to your web site? _____ Yes _____ No
May we list your group as a member on our website and in other materials? _____ Yes _____ No

ADDITIONAL INFORMATION FOR UMBRELLA ORGANIZATIONS ONLY:
We, the duly organized members of _________________________________________,
on __________________, 20_____ resolve to join Tammany Together, Inc.
Our current membership is __________ (households/persons).
A check for $25.00 is included with this membership application.
Primary Delegate ___________________________________		Email ____________________
1^st Alternate Delegate _______________________________		Email ____________________
2^nd Alternate Delegate _______________________________		Email ____________________
All delegates are residents of St. Tammany Parish and are at least eighteen (18) years of age. Our organization meets all the requirements of Umbrella Organization Membership.
_________________________	______________________	________________________
Authorized Signature	Title	Date
_________________________________________________		________________________
Name (Printed)		Telephone Number
Website Address: _______________________________________________________
May we link to your web site? _____ Yes _____ No
May we list your group as a member on our website and in other materials? _____ Yes _____ No

Tammany Together operates on a fiscal year beginning April 1st and ending March 31st. Dues are payable on April 1st of each year. Dues will not be prorated; however, any individual or group joining after January 1st will be deemed to have paid for both the remainder of the current year and the subsequent fiscal year.

Please mail your application form and check to: Tammany Together, Inc., P.O. Box 352, Mandeville, LA 70470-0352