Pioneer Village Membership
Page 1
Review
Thankyou
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
*
Individual Membership - $25
Family Membership - $35
Would you like the newsletter by email
*
Yes
No
Would you like to receive information on work parties?
*
Yes
No
Would you like to help in the kitchen?
*
Yes
No
Help at the Gate during events?
*
Yes
No
Help with music?
*
Yes
No
Help with Time Period Crafts?
*
Yes
No
Help with Building Maintenance?
*
Yes
No
May we list your contact information in a membership directory?
*
Yes
No
Help with Grounds/Gardening?
*
Yes
No
Help with the Electric?
*
Yes
No
Help with Plumbing?
*
Yes
No
Help by Providing Baked goods to be sold at events?
*
Yes
No
Help by representing the Village at off premises events?
*
Yes
No
Help with Maple Syrup collecting?
*
Yes
No
Help with Firewood cutting/stacking?
*
Yes
No