NELSON HOUSE MEMBERSHIP APPLICATION and RENEWAL FORM Name:_______________________________________________________
Address:_____________________________________________________
Phone Days:__________________ Evenings:_________ Fax #______________________

e-mail address:______________________________

New member [ ] or Renewal [ ]

Membership fee not required. Donation enclosed (optional)[ ] Amount:____________

I have read and support the Mission Statement and Beliefs of Nelson House:

Signature:__________________________Date:_______________

I am interested in becoming involved as a volunteer [ ] or committee member [ ]