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Response Form For Sagaponack Association

Name:___________________________________________________________________________

Sagaponack address:______________________________________________________________

Number of persons in your household: _________

Number of persons registered to vote locally: __________

Mailing address if other: __________________________________________________________

Telephone: _____________________________________________________________________

Fax: __________________________________________________________________________

E-mail: ________________________________________________________________________

___ Yes, I would like to join the SAGAPONACK ASSOCIATION

___ I am enclosing a check of $25 (made out to the Sagaponack Association) for the first year's membership (2003)

The main issues of concern to me in Sagaponack are:

_____________________________________________________________________________________

Mail this form with your $25 check to:
Sagaponack Association
P.O. Box 589
Sagaponack, NY 11962-0589

If at any time you would like to return to the membership page, click on the "return to membership" link below.

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