West Ghent Civic League

Online Membership Application

Applying online is an easy 3 step process. 

Step 1 - Fill out the applicable fields in the form below and hit submit button.  It will return you to this page afterwards.  You have not paid yet.

Step 2 - Select mode of payment.  If paying via the web go to our secure Online Store. If paying by U.S. Mail make check payable to "West Ghent Civic League" and mail to:  West Ghent Civic League, P.O. Box 11526   Norfolk, VA 23517.

Step 3 - The Membership Coordinator will contact you to within 1-2 weeks to confirm your info and that payment was received.  

Return to Home Page

 

Please provide the following information for the household or business:

First Name
Last Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Home Phone
FAX
E-mail
URL

Please describe yourself.  This demographic info will help us plan social events that appeal to a wider audience.

Age
Sex Male Female

Please list any additional adult member(s) in the household/business:

Name
Relationship
Age
Sex Male Female
Name
Relationship
Age
Sex Male Female
Name
Relationship
Age
Sex Male Female

Which mode of payment will you use? :

Pay online via credit card in the Online Store
Pay via check and mail to WGCL  
 

How many children in the household?


How did you find out about WGCL? (i.e. neighbor, website, newsletter, signs)


Please rate the value to you of this website (1 is highest value, 5 is lowest)?

1 2 3 4 5

M.R. Barclift WGCL Web Editor.
2009 West Ghent Civic League. All rights reserved.
Revised: 09/18/09