Household Registration for SaddleBrooke Community Outreach (Tax ID 86-0843458) - 2008/2009

This form is for Paypal payments only. If you do not want to pay on line, you can fill out the form at www.community-outreach.org/join.htm and submit it with your check payable to SaddleBrooke Community Outreach to Ken Siarkiewicz at 37104 S. Ridgeview Blvd (Unit 16, lot 52) 818-0425 or our office at 63675 SaddleBrooke Blvd, Suite L, SaddleBrooke Plaza - office hours M/T/W 9 a.m. to 8 p.m. Tax I.D. 86-0843458.

1. First and last name of first member
2. First and last name of second member
3. New members or returning members? (click down arrow to choose)
4. Active or supportive members? (click down arrow to choose)
5. We want to volunteer for the following (Optional - click down arrow to choose)
6. Street address in SaddleBrooke
7. Local telephone number (or cell phone number)
8. Unit number
9. Lot number (Optional)
10. Email address (Optional)