French Quarter Citizens     APPLICATION FOR MEMBERSHIP        2009

Please print and mail to:  French Quarter Citizens, 632 North Rampart Street, New Orleans, LA 70112

If paying membership online via Paypal, you may print and fax this form to 504.588.2929 or

use the Online Membership Form

Name ______________________________________Occupation __________________________
Name ______________________________________Occupation __________________________
French Quarter Address ___________________________________________________________
Mailing Address (if different) _______________________________________________________
F.Q./Local Phone ___________________Work Phone ___________________________________

Other Phones (cell, out-of-town, etc)__________________________________________________
Fax _____________________ Email _________________________________________________

Circle one: New Member / Renewal           If new member, which two members of FQC referred you:
1. ___________________________________  2. _______________________________________

Do you reside in the French Quarter?   ___Yes, full-time   ___Yes, part-time    ___ No
Are you registered to vote in the French Quarter?   ___Yes       ___No
If you reside/maintain a residence in the French Quarter, what year did you first move here? ________

What issue(s) would you like our organization to focus on this year? __________________________
_______________________________________________________________________________
 

Date: ________________
 

ANNUAL MEMBERSHIP DUES:   ____ Individual $25.00  or   ____Couple/Household $40.00

Dues Enclosed              $___________

Additional Donation      $___________

TOTAL ENCLOSED  $___________
 

Please make cheque payable to French Quarter Citizens

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