MEMBERSHIP                                                INFORMATION

                                                                                                Dues Paid by:  ____ check

                                                                                                                          ____ cash

NAME _________________________________________________________________

SPOUSE’S NAME  ______________________________________________________

ADDRESS  _____________________________________________________________

CITY  _______________________  STATE ____________________  ZIP  _________

PHONE NUMBER  (_____) ______-__________  BIRTHDATE _________________

E-MAIL ADDRESS ______________________________________________________

Are you a lifetime member?  (A member for 5 or more years)  Yes  _____  No _____

Would you be interested in being on the Board?  Yes  ________     No ____________

Would you be interested in volunteering on a committee?  Yes  _______  No  ______

When did you move to the Gallatin Valley?  __________________________________

Where did you move from?  (City and State)  _________________________________

Our Post Office Box:                                     Our Web Address: 

PO Box 10896                                                www.gallatinvalleynewcomers.org

Bozeman MT  59719                                    Mail completed form  with your $20 check

DISCLAIMER:

I understand that my participation in the above-mentioned activity is at my sole discretion

and I agree to hold Gallatin Valley Newcomers harmless and further agree to indemnify

Gallatin Valley Newcomers for any and all liability caused by my participation there from. 

I understand that Gallatin Valley Newcomers is a social and charitable organization that

exists to facilitate newcomers to the area to meet other newcomers  who enjoy doing the

same activities and for the making of distributions to organizations that qualify as exempt

organizations under section 501 (c) (3) of the Internal Revenue Code. 

SIGNATURE:  ________________________________  DATE:  __________________