Address:___________________________________________________________________

Phone:______________________________________________________________________

Do you want your number published if unlisted? Yes No

Name of Household members

1. ____________________________________________________

2. ____________________________________________________

3. ____________________________________________________

4. ____________________________________________________

5. ____________________________________________________

6. ____________________________________________________

7. ____________________________________________________

What is your line of work?____________________________________________

Would you or anyone in your household like to volunteer for a committee to help improve our neighborhood? Yes No

If yes, please list name and what you would like to volunteer for:

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Are there any available babysitters in your household that you would like to put on the babysitter call list for the neighborhood? If so, please list:

__________________________________________________________________________________________________________________________________________________________

Are there any other specialties or abilities that anyone in your household that you would like published in the Directory?____________________________

__________________________________________________________________________________________________________________________________________________________