Membership Application - May 1, 2016 to April 30, 2017

1. MEMBERSHIP APPLICATION
BROADWAY-FLUSHING HOMEOWNERS’ ASSOCIATION, INC.
P.O. BOX 580031, FLUSHING, N.Y. 11358-0031
SERVING THE COMMUNITY SINCE 1964
www.broadwayflushing.org
MEMBERSHIP DUES $25.00 PER YEAR (MAY 1, 2016 – APRIL 30, 2017)
Name ________________________________________________ Date __________________
Address ______________________ E-mail ____________________________ Telephone _____________
2nd Voting Member (over 21) _______________________________
PLEASE INDICATE: Member Renewal ________ New Member _________
Yes, I want to volunteer! We really need you! Please list interests: (i.e.: architect, legal, stuff envelopes,
garden judging, hospitality, etc.)___________________________________________________________
________________________________________________________________________________________
Please check if appropriate: ____ **IDO NOT HAVE AN E-MAIL ADDRESS AND
PREFER PAPER MAILINGS OF ALL MEETING NOTICESAND NEWSLETTERS**
***ADDITIONAL CONTRIBUTION TO STRENGTHEN THE LEGAL AND RESERVE FUND***
$___________Broadway-Flushing Homeowner: suggested: $50
$___________Broadway-Flushing Patron: suggested: $100
$___________Broadway-Flushing Benefactor: suggested: $200
$___________Broadway-Flushing Preservationist: suggested: $500
$___________Other
PROXY
I hereby appoint the highest officer of the Executive Committee present at the Membership Meetings of
the Association to appear for me to create a quorum and to vote for me as my proxy on all matters coming
before the Membership Meetings of the Association to be held in October, February and May. If I attend any
of the meetings, this proxy is void as to those I attend.
__________________________________________ _____________________________________
Signature, Printed Name and Address Second Voting Member Signature, Printed Name and Address