Name #1 __________________________________ Name #2 ______________________________________

Address   __________________________________ City   ­­­­­__________________    Zip Code  _____________

Home Phone  _______________________________ Work Phone ____________________________________

E-mail #1 __________________________________ E-mail #2 ______________________________________
                         (Provide e-mail only if you wish to receive e-mail bulletins from RHN.  Please print legibly)

Enclosed is my tax deductible membership dues of:

__ $20 Seniors    __ $25 Individual    __ $35 Household (two or more people)    __ $40 Merchant

Additional tax deductible donation:  General Fund  $______     Fay Park $______     Helen Wills Park $______

Number in Household:   ___ Under 18 years    ___ 18-30 years   ___ 31-50 years  ___ 51-64 years   ___ 65 or older

Memberships expire December 31 each year.  However, if you joined RHN as a new member after September 1 your membership is paid through the end of the following year. Thank you for your continued support!

 Please make checks payable to “Russian Hill Neighbors.”