2017 and Beyond Membership & Contribution Form
Please TYPE IN OR PRINT each section, print the completed form. Either mail it, or bring it to a Membership Meeting.

The POA - P.O. Box 386 - Oxford, FL 34484

 New Member          
 Renewal               Number of People in Household             

Name(s)(1):  

Name(s)(2):  

Address:  

Village:  

City/State/Zip:    

    Villages ID#:  

E-Mail:  

                            (We respect your privacy: your E-mail address is for POA official use only)

MEMBERSHIP DUES: ( Check Year(s) of your Choice )

 One Year - 2017 = $10 per Household  

 Two Year - 2017/2018 = $20 per Household   

 Three Year - 2017/2018/2019 = $30 per Household   

              ADDITIONAL CONTRIBUTION IF DESIRED:      $ 

TOTAL AMOUNT FOR DUES AND CONTRIBUTION:      $ 

 I will include a stamped, self-addressed envelope with this form and my check. Please mail my Membership Card to me.

 Please hold my Membership Card for me to pick up at one of the monthly POA meetings.

THANK YOU FOR YOUR SUPPORT AND CONTRIBUTION TO THE POA