Membership Application

Name *

First

M.I.

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Cell Phone

Email *

Birth Date *

Number of Years Residing in Newport Beach CA *

Prior Residence (City/State)

Spouse/Significant Other

First

Last

Emergency Contact Name (ICE)

First

Last

Emergency Contact Phone Number

How did you hear about Newcomers (member acquaintance, website, other)

Activities of Interest (check all that apply) *

Arts for the Heart
Book Group
Mah Jongg
Lunch Bunch
Menu Madness
Walking Groups
Coffee Klatch

Evening Activities with or without significant other

Happy Hour at local restaurant/bar
Fermented Friday at a member’s home

Volunteer Interest The Club’s success in sponsoring activities depends on member volunteers. Please indicate activities in which you would like to be involved.

Volunteer Interest *

Board Member
Chair an activity
Host a meeting
Host an event
Volunteer on a committee

Email

Email: npbnewcomers@gmail.com

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