BNA

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Items marked with an asterisk (*) are required; if you do not have email, we will need a phone number.

* First Name:

* Last Name:

* E-Mail:

Home Address:

Home City/St/Zip:

* Home Phone:

* Work Phone:

Fax:


	If you have a second member of your household or business, you may add them to this membership as well.

	First Name:
	Last Name:

All personal information will be used only for BNA purposes and will not be shared with any third parties. All mass emails will be sent as blind copies. Membership levels (per household):

INDIVIDUAL $15.00

FAMILY $25.00

PATRON $50.00

BUSINESS/ORGANIZATION $50.00

	Business Name:
	Business Address:

	Business City/St/Zip:

PREMIER:
If you'd like to make a contribution in any amount greater than these listed, it is appreciated! $

Note: The Beaverdale Neighborhood Association is a non-profit 501(c)(3). Your membership may be tax deductible and could be eligible for a matching gift from your employer.

What type of membership is this?

Please indicate areas of interest:
Public Affairs
Special Events
Beautification and Parks
Membership
Communications
Revitalization
History
Other skills/interests you can offer:

Submitting on-line provides you the option to pay with PayPal. If you prefer to pay with a check, please make it payable to "BNA" and mail to the following address::
Beaverdale Neighborhood Association
PO Box 30175
Des Moines, IA 50310

Beaverdale Neighborhood Association - P.O. Box 30175, Des Moines, Iowa 50310 bna@beaverdale.org