Member Application

Attention: If you navigate away from this page before submitting the form, you risk losing any data you may have input.

APPLICANT INFORMATION
* Registrant Type:
New member
Renewing member
* Member ID (renewing members only)
	look up your member ID
HUMANS:
1. Primary Owner Name (first to be contacted)
* First Name
* Last Name
* Street Address (Line 1)
Street Address (Line 2)
* City
* State	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, D.C. West Virginia Wisconsin Wyoming
* Zipcode
* Home Phone (format: xxx-xxx-xxxx)
Work Phone (format: xxx-xxx-xxxx)
Cell Phone (format: xxx-xxx-xxxx)
* Email
* Confirm Email
2. Other Person Responsible for Dog
First Name
Last Name
Street Address (Line 1)
Street Address (Line 2)
City
State	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, D.C. West Virginia Wisconsin Wyoming
Zipcode
Home Phone (format: xxx-xxx-xxxx)
Work Phone (format: xxx-xxx-xxxx)
Cell Phone (format: xxx-xxx-xxxx)
Email
Confirm Email
3. Dog Walkers/Pet Sitters permitted to bring dog to Park
First Name
Last Name
Company Name
Phone (format: xxx-xxx-xxxx)
Email
Relationship	dog walker friend family other
Additional dog walkers/pet sitters (please list full name, phone, email and relationship)
4. You must agree to serve on one committee this year. Please make three selections below.
* First Choice
Membership & Orientation Committee Landscaping, Workday, & Gardens Committee Trash & Recycling Committee Capital Improvements & Special Projects Committee Events & Fundraising Committee
* Second Choice
Membership & Orientation Committee Landscaping, Workday, & Gardens Committee Trash & Recycling Committee Capital Improvements & Special Projects Committee Events & Fundraising Committee
* Third Choice
Membership & Orientation Committee Landscaping, Workday, & Gardens Committee Trash & Recycling Committee Capital Improvements & Special Projects Committee Events & Fundraising Committee
5. * I have expertise in, and am willing to volunteer my help with, the following areas (check all that apply)
Legal (attorney)
What type of legal?	Real Estate law Tax law Non-profit law Litigation Other law
Construction
Landscaping
Website design/maintenance
Other information technology
Graphic design (signs, posters, etc.)
Dog training / behavior
None / I have no particular expertise / am unable to volunteer my expertise
6. * What else can you contribute to the Park and its success this year?
7. * What days of the week are you most likely to use the Park?
weekdays weekends both weekdays and weekends
8. * What time(s) of day are you most likely to use the Park?
before 8am 8am-11am 11am-2pm 2-5pm 5-8pm after 8pm
CANINES:
* Total Number of dogs	1 2 3 4 5 6
For Each Dog you must provide the following information

Membership Requirements and Waiver [Click here to view]
	* I agree that I have read and am familiar with the Membership Requirements and Rules of Friends of Orianna Hill Park.
	* I understand that the Rules are subject to change without prior notice.
	* I understand and agree that if I do not follow the Rules and serve on a Committee my membership may be revoked.
	* I understand that this contract may not be modified except by a writing signed by me, the Dog Park, and FOOHP.
	* I understand that the above Waiver and Release of Liability and Indemnification ("Waiver") is binding on my heirs and assigns, and that I have read and fully understand this Waiver.

* Member Orientation All applicants (including renewing members) must attend a member orientation session. The member orientation sessions will be held at the NLNA Community Center, which is at the corner of N. 3rd Street and Fairmount Avenue. To complete the registration process, please choose one of the following dates/times to attend your orientation session, at the end of which 2010 FOOHP dog tags will be distributed. If the choice listed is 1/1/2030, we currently have no upcoming orientations dates set. To proceed with this application, please choose 1/1/2030. We will set future orientation dates shortly, and will contact you by email to choose a date just as soon as we do.
8/19/2010 (Thurs.) 6:30pm9/12/2010 (Sun.) 4:00pm10/21/2010 (Thurs.) 6:30pm11/14/2010 (Sun.) 4:00pm12/16/2010 (Thurs.) 6:30pm
Make a Donation/Payment Now
Your tax-deductible donation to Friends of Orianna Hill Park allows us to maintain and improve the Park, a non-profit, member-run organization which receives no funding from the City. A $50 minimum annual donation (per person) entitles you to a Voting Membership, which makes you eligible to run for the Board and vote in elections, and to participate in voting members-only events.
Billing Information		same as Registrant?
First Name
Last Name
Street Address (Line 1)
Street Address (Line 2)
City
State		Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, D.C. West Virginia Wisconsin Wyoming
Zipcode
Phone (format: xxx-xxx-xxxx)
Enter amount here	$
		(minimum $50 per voting membership)