First Member's Name:   
Second Member's Name:
Home Address:       
City       State    Zip   

E-Mail Address:    First Member
E-Mail Address: Second Member
Home Phone:    


May we share your e-mail addresses
with other paid members? .............. YES  NO
Do you own or lease in Hillside?        OWN  LEASE

TYPE OF MEMBERSHIP:    REGULAR    SUSTAINING
                         $15.00       $15.00
                       NEW MEMBER RENEWAL

Would you be interested in serving
on any working committees at this time? YES  NO

Select one of the two payment methods below
and click on your choice to continue.

Checks should be made payable to:
Hillside Historic District Neighborhood Association
and mailed to:
Hillside Historic District Neighborhood Association
c/o 49 Hillside Avenue
Waterbury, Connecticut 06710