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Fill Out the form below to become a member of the Ballentine Civic Association*

Ballentine-Dutch Fork Civic Association 2018 Membership Form

*Membership requires and annual $20 fee

* Indicates required field

Name *

First

Last

Spouse Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

Your Occupation *

Spouse Occupation *

The Association is confronted with a wide variety of issues. Your knowledge is valuable to the community. What subject(s) can you offer advice on, to help with community issues? *

Children living at home? *

Yes No

If Yes, What are the ages of your children? *

PLEASE SELECT ALL AREAS THAT INTEREST YOU *

Membership Drive Christmas Party Growth/Zoning Newsletter Special Programs Schools/Public Affairs History Other

Please select all areas you will help with *

Membership Drive Christmas Party Growth/Zoning Newsletter Special Programs Schools/Public Affairs History Other

I want a MEMBERSHIP with voting rights--Dues $20.00 per family - per year *

Yes No

I want to be removed from the mailing list *

Yes No

I want to make a tax deductible contribution to the Association in the amount of: *

Mail dues and contributions to:
Ballentine Dutch Fork Civic Association
P.O. Box 270
Ballentine, SC 29002

Checks made payable to:
Ballentine-Dutch Fork Civic Association

Questions/Comments *

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​Ballentine-Dutch Fork Civic Association 2018 Membership Form

Ballentine-Dutch Fork Civic Association 2018 Membership Form