PSCC online Membership form

* Required Fields

Member Information:
Member name (s)  
* Name :
Company or Organization (for business and organizational memberships)
* Address 1:
Address 2:
* City:
* State:
* Zip:
* Phone:
* Email:

Membership Type

* Choose one
Credit Card Information
* Name on Card:
* Card Type:
* Card Number:
* Card Expiration: /
* Security Code:

Additional Information
(This information will help us plan community building activities and will be kept in strict confidence.)
My (our) greatest concern for Park Slope is:
I (we) would like to see the Civic Council take up these issues:
I (we) would be interested in volunteering for a PSCC
campaign/event/committee, and my (our) main area of interest is:
Number of children
How Would you prefer to receive the Civic News :
By Mail
By e-mail