WLNA Membership Application

Date:___________________________

Name:_________________________________________________________________________

Address:________________________________________________________________________

Home Phone:_____________________________ Other:________________________________

E-Mail:_________________________________________________________________________

In order to help our neighborhood organize as a group, please circle Yes or No to the following questions:

1. Would you attend neighborhood block parties? (ie: Fall Music Festival, Santa on skies Christmas Party, Fourth of July Fireworks) Yes No
2. Would you like to volunteer on a committee? Yes No
3. Would you attend a WLNA general meeting at the Lutz Civic Center ? Yes No
4. Would you like to see open forum discussions at our neighborhood block parties? Yes No
5. Do you want to help set up the Neighborhood Watch in your area? Yes No
6. Can we contact you to attend zoning hearings? Yes No
7. Depending on the issue, would you be interested in signing petitions regarding neighborhood issues? Yes No
8. Do you have a special skill that would be helpful to the WLNA? Yes No
9. Would you like to be a board member? Yes No
10.The newsletter will be coming out via e-mail. OK? Yes No

Do you have any specific neighborhood issues/concerns?_________________________________

_______________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

Membership: $50.00. Payable to: WLNA.

Mail to: Michael Hunt-Treasurer, 19101 N Dale Mabry Hwy, Lutz, Fl. 33548