NAME (AGE)

(IF YOU WISH, INDICATE ANY OF THE ABOVE CHILDREN WHO ARE AVAILABLE TO BABYSIT BY A “ * ” ON THE LINE WHERE THEY ARE LISTED ABOVE.)

ODD JOBS/OTHER SERVICES: ___________________________________________________

Are you interested in volunteering to attend the Pompey Town Board Meetings (even a few of them each year?)

   ___Yes  ___ NO

DO YOU WANT TO BE INCLUDED IN THE DIRECTORY (Y/N)? _______

ARE YOU A NEWCOMER TO POMPEY PINES? ______________________________________________________

Would you be interested in Social Get-Togethers? (such as last year’s picnic at Mill Run Park) Association dues are not used

for these events. Or would you be interested in joining the Welcoming Committee? Please indicate below.

___________________________________________________________________________________________________________

______________________________________________________________________________________________________

PLEASE RETURN THIS COMPLETED FORM AND YOUR YEARLY DUES OF $30 (MAKE CHECKS PAYABLE TO HOMEOWNERS’ ASSOCIATION OF POMPEY PINES) BY  April 30th to Florence Saleh 8134 Solomon Seal Lane. 682-7221