2019 DCA Membership

This form is for both returning membership renewal and new Darnestown Civic Association members

New this year: Business Memberships are now available for $250/year!

(DCA Business Members will be listed in each issue of the Little Acorn in a new "Darnestown Businesses" section)

Please complete this form to sign-up for your DCA Membership for 2019.

(If you are not sure whether or not you have paid your dues for this year, please check the DCA web site to view a list of those who have paid dues for 2019 at www.darnestowncivic.org)

I would like to join DCA as: *

An Individual or Household (select membership level below)

A Business ($250)

First Name *

Last Name *

Spouse/Partner first name

Spouse/Partner last name

How would you like to have your names listed in the annual listing?

My Business Name is: *

My Business Function is: *

Street *

City *

State *

Zip Code *

Phone Number *

E-Mail Address *

Please re-enter your e-mail address for confirmation *

DCA publishes a biennial directory which is mailed to Darnestown residents. Please un-check any information you don't want listed in this directory. Skip this section if you would like all of your information to be in the directory.

Name

Address

Phone Number

Spouse / Partner information

Select your desired membership level *

Business Member order confirmation *

Yes, I want the Business Membership

You may pay for your DCA membership with either a check or by using our Pay Pal site for a Credit/Debit card payment. When you click on "Next", you will first be taken to a submit confirmation page - then you will be taken to the payment option page where you may select to pay with either a credit/debit card (our PayPal account), or you may choose to pay by check. If you choose to pay by check, please make your check out to Darnestown Civic Association and mail to: DCA Membership, 12600 Viewside Dr., Darnestown, MD 20878. Upon completion, you will be returned to a "Successful Payment" message.

Questions?: Contact DCA Treasurer (Guy Armantrout) at treasurer@darnestowncivic.org or 240-426-1898.

I plan to pay by: *

Check

Pay Pal (credit / debit card)

N/A