Membership Form

Cohoes Caretakers Membership Form

Name:

Title: First:Middle: Last:Suffix:

Address:

P.O. Box: House No. Street:

City: State: Zip Code: Postal Code:

Phone: Fax: Email:

Membership Class:

	*Each membership class is entitled to one vote. Business, Clubs and Fraternal Organizations please designate the individual authorized to cast your vote.*
Title: First:Middle: Last:Suffix:

*The Caretakers have several areas where we are currently providing support. Please check any or all areas that you would like to volunteer your time and talents.*
	Community Events (Concerts, fireworks, tree lighting etc.
	Volunteer research, special events)
	Work Groups (Canal Square, etc..)
	Other:

Print Membership Form with Check payable to Cohoes Caretakers, Inc. mail to:

Cohoes Caretakers, Inc.
P.O. Box 200
Cohoes, NY 12047

Enter information and submit form and you will be contacted.