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MEMBERSHIP FORM
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Name
*
Street Address
*
Preferred Method of Contact (select one)
*
Phone
Email
Mail
Email
*
Phone Number
*
Mailing Address
If different than above
Please indicate your primary connection to the Bankhead community (check all that apply):
*
Current resident
Former resident
Long-term inhabitant (10 years or more)
Business owner/operator in Bankhead
Unhoused in the Bankhead area
Connected through family or community ties
Other
If you selected former resident, long-term inhabitant, or other, please briefly explain your connection:
Current Employment Status (check all that apply):
*
Employed
Student
Disabled
Veteran
Unemployed
Retired
Children in Household:
*
Yes
No
If yes, number of children living in the household:
What is your best memory of Bankhead?
What is the hardest thing you remember or see in Bankhead?
Bankhead Address Email
Communication and Media Consent:
*
I consent to receive communications from the organization, including updates, event information, and relevant announcements via email, phone, or text.
I consent to the use of photographs, video, and audio recordings of me for promotional, educational, and informational purposes related to the organization or event.
I do not consent to media use or to receiving communications from the organization.
Membership Agreement
*
By submitting this application, I affirm that the information provided is accurate to the best of my knowledge and that I support the mission and values of the Bankhead Community Association.
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