2018 and Beyond Membership & Contribution Form
TYPE IN or PRINT ON THIS FORM to PAY BY CHECK.
Then, print the completed form. Either mail it to
The POA - 8736 SE 165th Mulberry Lane, PMB 111, The Villages, 32162
or bring it to a Membership Meeting.
OR...
 New Member            Renewal             
 Number of People in Household               Member ID (if known)             

Name(s)(1):  

Name(s)(2):  

Address:  

Village:  

City/State/Zip:    

    Villages ID#:  

E-Mail:  


MEMBERSHIP DUES: ( Check Year(s) of your Choice )
 One Year - 2018 = $10 per Household  
 Two Year - 2018/2019 = $20 per Household   
 Three Year - 2018/2019/2020 = $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