Pioneer Village Membership

Page 1

Fields

First Name: *
Last Name: *
Spouse:
Child 1:
Child 1 Date of Birth:
Child 2:
Child 2 Date of Birth:
Child 3:
Child 3 Date of Birth:
Child 4:
Child 4 Date of Birth:
Child 5:
Child 5 Date of Birth:
Address 1: *
Address 2:
City: *
State: *
Zip Code: *
Phone Number: *
() -
Email: *
Membership Type *
Would you like the newsletter by email *
Would you like to receive information on work parties? *
Would you like to help in the kitchen? *
Help at the Gate during events? *
Help with music? *
Help with Time Period Crafts? *
Help with Building Maintenance? *
May we list your contact information in a membership directory? *
Help with Grounds/Gardening? *
Help with the Electric? *
Help with Plumbing? *
Help by Providing Baked goods to be sold at events? *
Help by representing the Village at off premises events? *
Help with Maple Syrup collecting? *
Help with Firewood cutting/stacking? *