MEMBERSHIP FORM

Please use this form to indicate your interest in joining the West Shore Singles Network.

This page allows you to directly contact West Shore Singles Network concerning membership and activities. The information you enter is confidential. WSSN will not share or distribute your personal information with any other organization without your specific written permission. With your permission indicated below, We plan to share basic information about members and their interests in a password protected file.

Please enter any information you wish, then click the SUBMIT button at the bottom of the page.

* Required Responses

Name, First *	Last *
Street Address
Street (line 2)
City *	State Zip
E-mail Address:
Work (Area)	Ext
Mobile (Area)
Home (Area)

Business/Job Information

Areas of Special Interest

Would you consider volunteering for any of the following activities or committees?

Membership	Yes No Maybe
Greeter at Parties	Yes No Maybe
Board Member	Yes No Maybe
Activities Planning	Yes No Maybe
Website/Technology	Yes No Maybe
Advertising/Publicity	Yes No Maybe

Would you like to make your basic membership infomation (the pale green fields on this form - Name, City, e-mail, and Interests) available to other members in a password protected file?

Membership dues are $20.00 ($10.00 after July 1) to join and an annual renewal fee of $10.00 due each February.
Please activate your membership by sending a check or money order payable to:

West Shore Singles Network
PO Box 1288
Muskegon, MI 49443

If you wish, you may enter a MESSAGE in this text area.