The Pleasant Run Farms MEMO “An Active Community” June 2013 Volume 45 Issue 6e www.pleasantrunfarms.org A publication brought to you by the PRF Civic Association

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Calling all men 18 and up from Pleasant Run Farms!

We are recruiting for our annual Skirt Softball Game on July 4th. If you like to play soft-

ball, enjoy fun family events, and don’t mind wearing women’s clothing, then you are just

who we are looking for! The skirt game will follow the PRF July 4th Parade at Clifford

George Fields. This an event for all families, food, drinks, raffle, and lots of fun! This

year all donations from this event will go to The American Heart Association. Come out

and support your neighborhood and a great cause! Anyone interested in playing please

send an email.

Thank you! Cheryl Purvis, craftycp@yahoo.com

PRF 4th of July Parade

It’s never too early to be thinking about how to decorate your bike or car or organize a group to take

part in the July 4th Parade. We are adding a new feature this year. Lawn mowers. So get those

mowers out, remove the blades and join the fun. As in the past, we will meet at John Wesley United

Methodist Church in the morning and follow the usual route. If you would like to participate please

send me an email at laboylson@yahoo.com at your earliest convenience.

Linda Boylson, Community Activities Director

Landscape Contest

Hard to believe but the Contest will indeed take place this year despite the weather.

Judging of landscapes will take place during the month of June and the winners will

be announced at the end of the July 4th Parade at Clifford George Fields. Due to the

economy, there will be no prizes awarded this year but you will receive the bragging

rights to having the most beautiful yard in the Farms with a sign to prove it. Good

luck and happy planting.

Linda Boylson, Community Activities Director

New Art Camp Starts in Springfield Township

Children can beat the heat this summer by spending Monday afternoons creating artwork, having fun,

and making friends! The Springfield Township Arts & Enrichment Council is hosting an all NEW Sum-

mertime Kids Art Camp for kids ages 7-12. The three-hour camp will be held on Mondays from 1-4 pm

at the Springfield Township Senior & Community Arts Center. With support from the Greater Cincin-

nati Foundation, camp fees have been reduced from $135 per session to $120 per session! Each session

consists of four Mondays. Two sessions will be offered, however space is limited to 15 students per session.

http://www.springfieldtwp.org/kidsclasses.cfm

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Hard Copy Issue Advertising Rates:

Back Full Page $110 Regular Full Page $90

Half Page $65 Quarter Page $45

Business Card Size Ad $25

Classified Ad $8

Electronic Issue Rates are 1/2 the cost of

Hard Copy Issue Rates

Contact Venita Vivians at

vvivians@prodigy.net to place your Classi-

fied or Business Ad.

Memo Deadline for Advertisements and Articles

Friday, June 28, 2013

The July Electronic Copy Memo Delivery will occur the

weekend of June 1st. The memo will be available on the web-site, www.pleasantrunfarms.org, by July 6, 2013. If you would like to place an ad in or contribute an article to

the Memo, please contact Venita Vivians, Memo Editor at vvivians@prodigy.net (include Memo in the sub-

ject). If you have any problems with receiving your

Memo, please contact Susan Scheib at 931-3508.

The Memo and the PRF Civic Association reserve the

right to refuse any content. Letters to the editor will be published only with the authors name. Any comments,

suggestions, or new contributors are welcome.

The MEMO is published by the Pleasant Run Farms Civic Association,

11955 Elkwood Dr., Cincinnati, Ohio 45240

www.pleasantrunfarms.org

PRFCA Membership Applications are available in this

memo and on the website listed below or by calling

our Membership Chairperson listed above.

Dues are $25 a calendar year.

Check out the website below for additional news and

community information.

www.pleasantrunfarms.org

YOUR PRF EXECUTIVE BOARD MEMBERS:

Kevin Puccini kevinpuccini@yahoo.com (President)

OPEN (VP)

Ed McNett 377-4463 emcnett@opwftg.com (Treasurer)

Christina Norris 851-3013 cdnorris2004@yahoo.com

(Secretary)

Judy Nelson 851-5447 jcsmith1@cinci.rr.com

(Membership)

Linda Boylson 674-1760 laboylson@yahoo.com

(Community Activities)

Tonya Klei 742-0385 tonya1@zoomtown.com (Swim Club)

Erin Knox 742-0981 erinlknox@gmail.com (Athletics)

Venita Vivians vvivians@prodigy.net (Communications)

Pleasant Run

Dry Cleaners Same Day Service-

In by 10:00 Out by 4:00

Shirt Laundry

FREE Minor Repairs

Ask for our 20% off Dry Cleaning

Card

6106 Winton Road at Mack Road

(between Jay’s Food Mart & Domino’s Pizza)

Fairfield, OH

829-4441

3 PRFCA GENERAL MEETING MINUTES

Pleasant Run Farms Civic Association

Association Meeting

May 16, 2013

A meeting of the Pleasant Run Farms Civic Association was held Thursday, May 16th, 2013 at 7:00pm at the swim club. The

following are the minutes from that meeting:

The meeting was called to order at 7:42pm.

President: Kevin Puccini reported he has received concerns related to parking issues during ball games at Clifford George

Field such as parking along Mill Road. Discussion of entrance signs being placed at various points for the PRF community

and how we can make this happen.

Vice President: POSITION OPEN AT THIS TIME.

Treasurer: Ed McNett – not present.

Secretary: Christina Norris will be contacting the Northwest Board of Education this summer regarding securing the Welch

Elementary library for General Meetings next year.

Athletic Director: Erin Knox – not present.

Communications: Venita Vivians reported the June memo will be an electronic memo emailed the weekend of June 1st. Ads

and articles for the memo are needed by next Friday. Discussed articles needed for the June memo.

Membership Report: Judy Nelson reported 2013 member discount cards have been received and will be distributed. Judy

would like to try revising the street rep program to recruit new members and welcome new residents into the community. A

brochure about our community was created in the past couple of years and we will try to duplicate and utilize these.

Community Activities: Linda Boylson reported about 10 people volunteered for the Great American Cleanup in our commu-

nity, down from previous years. Flowers were planted and beds were mulched at Clifford George Field and areas of PRF were

cleaned up. The PRF garage sale will be held Saturday, May 18th and is being advertised in the Enquirer. Residents are en-

couraged to take part in the annual 4th of July parade by being a spectator or decorating a bike, wagon, or riding mower

(blades removed). Lineup will be at 9am at John Wesley church; parade will begin at 10am. The landscape contest will again

be taking place this year, with the winner announced at the skirt game following the parade.

Pool: Tonya Klei reported there are 36 swim club members thus far, exceeding the pace for last year at this time. The pool

will be inspected tomorrow. New fence has been installed separating the baby pools from the adult pool, with an improved

locking system. There will be several new food items offered at the concession stand this year.

Old Business: None

New Business: None

Announcements: Cheryl Purvis, resident of PRF, attended the start of tonight's meeting to

present information on the annual 4th of July skirt game, taking place at Clifford George

Field immediately following the parade. Donations have been given from Meijer for the

food and supplies for the game. A raffle will be held for a Cincinnati Reds-themed gift bas-

ket, and a possible split the pot. Proceeds will benefit the American Heart Association and

donations will also be accepted. Players in the skirt game are still needed – contact Cheryl at

craftycp@yahoo.com or 851-2871 to sign up.

Being no further business to come before the Board, the meeting was adjourned at 8:03pm.

Next meeting: June 19th, 2013 at 7:00pm at the swim club.

Christina Norris, PRFCA Secretary

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Join the

Pleasant Run Farms Swim Club 11955 Elkwood Drive. 851-7109

(You don’t have to live in Pleasant Run Farms to join!)

The pool is located on Elkwood Drive, off of West Kemper Road, in between Cedar-

creek and Deerhorn Drives. We have two great baby pools in an enclosed area and a

main pool with a certified lifeguard on duty. We offer a swim team and swim les-

sons. We are available for rentals; during pool hours, rent our shelter and have a

party, or stay from 8 to midnight for an after hours party. Stop by for a membership

application or download a form from the web at www.pleasantrunfarms.org. Pay in

full by May 10th and receive 5 free guest passes.

It is a great place to spend your summer!

For more information contact Tonya Klei, pool director at tonya1@zoomtown.com

RECYCLE DUMPSTER—CLIFFORD GEORGE FIELDS

Help keep the recycle dumpster at Clifford George Fields clean. The receptacle is heavily used

and plays an important role for recycling in our community. Please keep in mind that this is

not a trash receptacle or a place to drop off furniture. It is the gateway to your park. If you see

anyone illegally dumping materials into the recycle dumpster, please call 729-1300—the non-

emergency Police Department phone number.

Kimberlee Flamm, Springfield Township Project, Events & Communications Coordinator

SWIM LESSONS AT PRF SWIM CLUB

Swim lesson registration will begin Memorial Day weekend. Group and Private lessons are available.

Learn-to-Swim

Red Cross Learn-to-Swim features six levels of instruction to help swimmers of all ages and abilities develop their skills.

Level 1—Introduction to Water Skills

Level 2—Fundamental Aquatic Skills

Level 3—Stroke Development

Level 4– Stroke Improvement

There are 5 classes in a session and are 30 minutes long. Sessions run Monday through Friday

from 11:30am to 12:00 pm. Call or stop by the snack bar at the pool after May 28th to register.

Cost is $35.00 for PRF Civic Association members and $45.00 for Non-members. 513-851-7109

Pleasant Run Farms Swim Club

Tonya Klei, Swim Club Director

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Pleasant Run Farms Swim Club Registration The membership drive for the Pleasant Run Farms Swim Club has begun. If you have any questions,

contact Tonya Klei at prfswimclub@yahoo.com. Please complete the registration form and submit

payment in one of two ways:

1. Pay by cash or check or credit card (make check payable to the PRFCA Swim Club) and mail to:

PRFCA Swim Club, 11955 Elkwood Drive, Box B, Cincinnati, Ohio 45240, or drop the registration

form and payment off at the Pool from 12-8pm beginning Saturday, May 25 from 12-8.

There will be a $15 fee assessed for all non-sufficient fund checks.

2. Pay by credit card by visiting our website www.pleasantrunfarms.org and click on swim club.

Payment plans available online only.

If you join by May 10th and your membership is paid in full you will receive 5 free guest passes.

Membership Options PRFCA

Member

PRFCA

Non-

member

Family Membership $ 225 $250

Couples Membership $ 185 $210

Single Membership $ 135 $160

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Membership Information

PLEASE NOTE: All members listed on this membership form must reside in the same house.

Membership Type: ___ Family ___ Couple ____Single PRF Civic Assoc. Member ___Yes ____No

Last Name: ____________________________ Adult First Names: __________________&____________________

Address: _______________________________________________________________________________________

Email address: ___________________________________________________________________________________

Phone #:__________________ Emergency contact &phone #: ____________________________

Children’s Name + Male or Female Age Date of Birth

+Please include the children’s last name if it is different than the family name above.

I agree to obey the rules and regulations of the Pleasant Run Farms Swim Club, and will not hold the Pleasant

Run Farms Civic Association or any member responsible for any injury that my family or I may sustain while at

the pool. Failure to obey the swim club rules and regulations will result in forfeiture of membership. Guests

must be accompanied by a member to use the pool facilities

______________________________________ ____________________________

Parent or Legal Guardian’s Signature Date

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St. John Neumann

2013 Festival Raffle

Up to a $10,000 GRAND PRIZE*

Sales for the 2013 St. John Neumann Festival Raffle have officially begun. In conjunction with our

Annual Parish Festival (Aug. 30th

,31st & Sept. 1

st) we will be giving out up to a $10,000 Grand Prize

on Sunday September 1st.*

Two Early Bird Drawings!!!

We will have an early bird drawing for $500 in gift cards of your choice from the SJB Shopping

Cents, to be held at our annual Festival kick-off Spaghetti dinner on July 13th

in Daniel Hall. A

second early bird drawing for another $500 gift in Shopping Cents gift cards of your choice will be

held on August 18th.

A maximum of 500 tickets will be sold for this RAFFLE with the hope that all 500 tickets are sold

prior to the start of the festival. You now have the opportunity to purchase and/or sell tickets by mail

and be eligible for the EARLY BIRD DRAWINGS (and remember that the EARLY BIRD

winning ticket remains eligible for the GRAND PRIZE to be awarded Sept. 1st). To order tickets,

enter your information in the space below and return it with $50.00 to:

St. John Neumann Church

12191 Mill Road

Cincinnati, Ohio 45240

*based on a minimum of 420 tickets sold. If fewer than 420 tickets sold, Grand Prize will be ½ of the Net Proceeds received. See complete rules on the back of this form

(Please detach here and return lower portion with your check)

2013 St. John Neumann Festival Raffle ticket request

Ticket Owner ____________________________________________________

Address_________________________________________________________

City, State Zip____________________________________________________

Phone#_________________________________________________________

Number of Tickets Requested_______@$50.00 per ticket

Total Amount enclosed $___________________

For shared tickets please provide additional information below

Name ________________________ Name ________________________ Name ________________________

Address_______________________ Address________________________ Address________________________

Name _______________________ Name ________________________ Name ________________________

Address______________________ Address_________________________ Address________________________

Name _______________________ Name ________________________ Name ________________________

Address______________________ Address_________________________ Address________________________

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Did you know Pleasant Run Farms is on Facebook?

Join the Pleasant Run Farms Civic Association Group Today.

What a powerful tool to bond and share information in our community!

June Fun Facts

Birthstone—Pearl

Flowers—Rose

June is National Candy Month, National Dairy Month and National Iced Tea Month

June is the month with the longest daylight hours in the Northern Hemisphere and the shortest daylight

hours in the Southern Hemisphere.

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VOLUNTEER WITH SPRINGFIELD TOWNSHIP

Troop 881 welcomed their newest Eagle Scout, Justin Bergquist, during a Court of Honor held April 28 at John

Wesley United Methodist Church. Justin is a sophomore at North-

west High School.

Justin began his scouting journey as a Tiger Cub in Pack 929. After

earning his Arrow of Light, Justin joined Troop 881, where he served

in a variety of leadership positions, including Patrol Leader. His Ea-

gle project involved improvements to the outdoor concession stand

at Pleasant Run Middle School in Colerain Township for the North-

west Mighty Knights Youth football program. These improvements

included adding steps and platforms to reach the concession win-

dows, as well as drainage improvements.

Justin is a member of the concert band, Student Senate and Aca-

demic Quiz team, as well as the football and track teams at North-

west.

Troop 881 is sponsored by John Wesley United Methodist Church in

Springfield Township.

Chip Bergquist

SPRINGFIELD TOWNSHIP SCOUT EARNS EAGLE

Are you seeking a creative outlet for your free time? Do you want to volunteer for a project that uses your skills and training or

do something new and completely different? The Council is appealing to all Springfield Township residents to come forward and

help us in our undertaking.

During the past few months, the Springfield Township Arts and Enrichment Council (STA&EC) has been involved in several new

and impressive programs to further the organization’s goal of bringing the finest in arts and enrichment programs to the commu-

nity. Most recently , these projects consisted of a series of dinner theater shows, outreach programs with the Cincinnati Play-

house in the Park, children’s events and activities, Art and Wine Wednesdays, the ArtLocal art show and the Kids Art Club.

The wide acceptance of these initiatives shows the enormouse progress that the Arts and enrichment Council has made. How-

ever, the better serve audiences, the Council needs volunteers. Our initiatives can only be sustained with help of volunteers who

would be available on an as-needed basis for events or may be willing to spare a couple of hours every month or week.

The Springfield Township Arts and Enrichment Council has many opportunities for you to share your talents, skills and gifts

through the programs within the Council’s five operating divisions—literary arts, visual arts, performing arts, student art educa-

tion and grants/fundraisers. We are also seeking support in administrative duties, hospitality, event logistics and many other

areas. We would love to get you or your community group involved.

To learn more about jointing our volunteer team, simply fill out our Arts Council Volunteer Form found online at

www.springfieldtwp.org/artscouncil.cfm.

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Kids Looking for Work!!!

Following is a list of young residents looking for work. The PRFCA/Memo does not endorse any of those listed; we list these names

free of charge as a service to our community….

Babysitting:

Elese Boylson, age 14, 259-9143, basic C.P.R., very good with kids including babies, schedule is EXTREMELY flexible

Sarah Dean, age 14, 674-9455, Red Cross babysitting course, CPR & First Aid trained/certified (spring 2011), babysitting and/or

mother’s helper

Maddie Girts, age 16, 648-9766, CPR certified, has own transportation for babysitting jobs

Claudia Weitz, age 13, 825-3448, American Red Cross babysitting course

Yard Work/Pet Care/Odd Jobs:

Sarah Dean, age 14, 674-9455, pet care

Louis Girts, age 14, 648-9766, yard work, car washing & other odd jobs

Jay Sebastian, age 12, 502-0002, mow lawns, shovel snow, rake leaves, general cleaning

Tutoring:

Deja Martin—age 15, dmartfam@gmail.com, Northwest honor student

2013 COMPUTER AND TV RECYCLING DROP-OFF

Free to Hamilton County, Ohio Residents Only. Bring proof of residency such as a driver’s

license or utility bill.

This program prohibits the acceptance of computers and electronics from businesses,

churches, schools, and non-profits.

This program is held on Saturdays only.

Saturday Dates and Hours: May 4 through October 26, 2013; 8 am—Noon (Closed May 25 and August 31)

Drop-Off Locations: Cohen Norwood, 5038 Beech Street, Norwood, Ohio 45212

Cohen Norwood, 4538 Kellogg Avenue, Cincinnati, Ohio 45226

Items accepted at no charge:

Back-up batteries, cables, cell phones, chips, circuit boards, cameras, CD/DVD players, CPUs, video game con-

soles, fax machines, GPS units, keyboards, laptops, main frames, mice, monitors, PDAs personal copiers, printers,

scanners, speakers, televisions, telephones, video equipment.

For more information, visit HamiltonCountyRecycles.org or call 946-7766

Take advantage of other drop-off programs:

Yard Trimmings Drop-Off Sites

Household Hazardous Waste Drop0Off Program

Information from Hamilton County Recycling and Solid Waste District, michelle.balz@hamiliton-co.org

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Your Celebration News

Living in the Farms Anniversaries—June 2013

Jean & Burton Crosby ~~~~~~~~~~~ 1976 ~~~~~~~~~~~~~~~~~~ 37 years

Joanne Glaser & Bob Larson ~~~~~~~~~~~~~ 1977 ~~~~~~~~~~~~~~~~~ 36 years

Chip & Nancy Bergquist ~~~~~~~~~~~~~ 1992~~~~~~~~~~~~~~~~~~ 21 years

Bryan & Amy Doloresco ~~~~~~~~~~~~~ 1995 ~~~~~~~~~~~~~~~~~~~ 18 years

Susan Butts ~~~~~~~~~~~~~2003 ~~~~~~~~~~~~~~~ 10 years

Michael & Latosha Posey ~~~~~~~~~~~~~~ 2004 ~~~~~~~~~~~~~~~~~~~~~ 9 years

Brad & Melissa Fraser ~~~~~~~~~~~~~ 2008 ~~~~~~~~~~~~~~~~~~~ 5 years

Joe Howard & Wanda Ostlund ~~~~~~~~~~~~~ 2010 ~~~~~~~~~~~~~~~~~ 3 years

Betty Hutzel & Mary K. Telinda ~~~~~~~~~~~~~ 2012 ~~~~~~~~~~~~~~~~~ 1 year

Neal & Misty Jackson ~~~~~~~~~~~~~ 2012 ~~~~~~~~~~~~~~~~~ 1 year

Happy Birthday to You, June Birthdays!

3rd

Alex Bergquist

6th

Conner Puccini

7th

Daryl Pearson

Jeremy Purvis

10th

Justin Bergquist

Brooke Erin Cook

11th

Vicki Boschert

12th

Jay Sebastian

13th

Ben Ferguson

15th

Michele Kluener

Al Neumann

16th

Linda Boylson

Eleanor Gaynor

Willi Olson

17th

Sharon Obert

18th

Susan Butts

19th

Kevin Carroll

Patricia Tisone

20th

Donna Carroll

Venita Vivians

22nd

Mary Davidson

Tony Davidson

Tom Mayer

23rd

Mina Breuer

24th

Randy Scheib

Maddie Veite

25th

Ebony Carruth

26th

Christina Norris

27th

Beth Akemon

Bob Larson

29th

Marc Ferguson

Bev Gutknecht

30th

Wendy Puccini

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A reminder to all PRF civic association members, memberships run from January 1 through December 31 of

each calendar year. Your Community and the Civic Association needs your membership dues at the end of

each calendar year for the coming year and you receive the maximum benefit from your membership! It is

time to submit your membership for 2013. Application is on the back page of this memo or

available at www.pleasantrunfarms.org . Thank you for your continued support.

PRF Civic Association

Pleasant Run Farms Civic Association (PRFCA) exists to ensure a better quality of life for residents by offering a variety of

volunteer opportunities for community involvement and commitment. The PRFCA does this by encouraging community

awareness of Springfield Township resources, youth athletic programs, and a community swimming pool: and in offering a

schedule of social activities giving membership/residents a way to “get to know each other.”

PRFCA provides a variety of leadership opportunities for those who choose to get involved. Past leaders have contributed

many benefits for community improvement such as liaison with Township on planning projects and maintenance of our com-

monly held Green space, communication with residents via the Memo or on the Website. PRF property values are enhanced

by the existence of a Civic Association and would be further enhanced with increased membership. A strong Civic Associa-

tion benefits the entire community and is what separates us from being “just another neighborhood.”

PRFCA membership is currently open to any family or family member who would like to become involved in their community.

Opportunity for involvement is never ending from serving on the Civic Association Board to coaching to helping out with sev-

eral of the social activities offered.

Ensure PRF’s future: GET INVOLVED

Pleasant Run Farms Civic Association Mission Statement

PLEASE JOIN THE PRF CIVIC ASSOCIATION

Here’s why:

The membership pays for itself when you use member discounts at local merchants, i.e. 25% off regular menu price at

Papa John’s on Kemper Road, 10% off Skyline Chili on Kemper Meadows, to name a few.

Because our neighborhood has a working Civic Association, we have an effective voice with Springfield Township. Here

are some of the items that were discussed at previous meetings:

Potential uses for Welch Elementary if the Northwest District would close the school.

Retail redevelopment on Hamilton Avenue.

Ways to preserve our neighborhood pool.

Your membership fee helps pay for the insurance necessary to preserve and protect the Greenbelt. You will have voting

rights at association meetings. Also, the publication of the neighborhood newsletter, ―The Memo‖ is supported mostly by

your membership fee.

The Civic Association members help ensure community events and opportunities continue, maintaining a high quality of

life and protecting the value of our homes and neighborhood.

Some other things your Pleasant Run Farms Membership dues support:

Scholarship Fund

Landscape Contest

Neighborhood Garage Sale

4th of July Parade

More information available on www.pleasantrunfarms.org.

PRFCA MEMBERSHIP REMINDER

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2013 Pleasant Run Farms Civic Association, Inc. Membership Form

Date:________________ Family last name:________________________________________________________________

Address: ____________________________________________________ Phone:_________________________________

E-mail (please print clearly): ______________________________________________________________________________

PRF Resident since: month ________ year _________ Check One: Membership Renewal ________ New Member:_______

Please note your personal information including e-mail address is only used by the PRFCA to contact you regarding events and issues that pertain to our community. We respect your privacy and do

not distribute, sell or trade any of your personal information.

The success of the Civic Association largely depends on volunteers in the community. Volunteers play an integral role in keeping programs in existence and run-

ning smoothly. Please check if you are willing to help with any of the following programs and the respective Board Member may contact you for assistance.

4th of July Parade____ Scholarship Committee____ Where needed____

Garage Sale ____ Membership____

Landscaping Contest____ Communications____

Swim Club____ Sports____ (specify which sport _______________________)

We publish members anniversary (years living in PRF) and birthdays in the Memo.

I do not want household anniversary and birthdays published in the Memo.

The Memo is electronically distributed monthly to members of the civic association only. The memo will be distributed to the entire PRF community during the

months of January, April and September in hard copy form. If you are a member and require a hard copy of the memo monthly please indicate below:

I need a hard copy of the memo.

If you have a child and he/she participates in sports, you must be a member. Annual 2012 Membership fee: $25.00. Please return this completed form with your

check. Please make your check payable to PRFCA and mail or drop off to: Ed McNett, 1403 Forester Drive, Cincinnati, Ohio 45240.

If you have any questions, please call Judy Nelson at (513) 851-5447 or via email at jcsmith1@cinci.rr.com

Please check out the PRFCA website at pleasantrunfarms.org. We are also on Facebook under Pleasant Run Farms Civic Association. Please give your comments

and upload any pictures which involves the Farms. Please become a fan or join the group! Thank you for your support!

Household Member Birth month/day Adult/Child

Membership Use Only:

Date Received:__________ Check #_________ Amount:_________ Date Cleared:__________ Membership card:____________