Use your computer to fill out the form and print it. When you get this electronically, open the attachment click on “Enable All Features” on the upper right of the page. This will allow you to TYPE in all the required information. If you are having trouble downloading the form because it is the most recent edition of Adobe, print the form and write very very neatly all the information.
Use the CAPS LOCK when typing in this form.
DO NOT TAKE YOUR RENEWAL FORM TO WESTOVER PASS AND ID. This form can only be processed by Dave Carbin.
Include your annual dues payment of $75 and mail to GCC.
Section I – LINE INSTRUCTIONS:
Last Name / Suffix if applicable (i.e. Sr. / Jr. / III/ IV / V / VI )
First Name / Middle Name (No Middle Initial) If no Middle Name Leave Blank
Date of Birth (DD/MM/YEAR). Example 06/16/1970.
Home Phone or Cell Phone to Include the Area Code
Height / Weight / Eyes / Hair ( Example, 5’ 9” /125 / BLUE /BLOND )
SSN: Required for all Transactions.
Home Address to include Street Number / City / Town / State or Province/zip Code or Country Code.
Driver’s License Number / State of Issue / Expires: Year, Month, Day – You must show your drivers license when you go to pick up your ID.
Applicant Category: VOLUNTEER
Are you a United States Citizen: YES
SECTION II – APPLICATION ACKNOWELDGEMENT
Company/Organization: Galaxy Community Council
Date: Today’s Date
SIGNATURE – SIGN HERE
Allow 15 Business Days for all Background checks.
If you have a question, contact Dave Carbin at DFCarbin@yahoo.com