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MEMBERSHIP APPLICATION 2009-2010
www.barringtonilnewcomers.org
New Member _______ Renewing Member _______
General Information (required, please print)
Name ________________________________________________________DOB__________
Month/day
Address _____________________________________________________________________
Home Phone ____________________________ Cell_________________________________
E-Mail Address _______________________________________________________________
Relocated From _______________________________________________________________
Spouse’s Name ______________________________________________
Child(ren)'s Age(s)____________________________________________
Programs and Activities
(please check areas of interest)
Daytime/Weekday Evening/Weekend
□ Almost Gourmet □ Bunco
□ Book Club □ Book Club
□ Investment Group □ Game Night
□ Game Group □ Weekend Couples Card Group
□ Moms & Tots Play Groups □ Weekend Gourmet
□ Bowling □ Wine Tasting
□ Golf
□ Tennis
□ Coffee & Conversation
□ Bridge
• Please list any suggestions you have for a new activity or program.
• Please list any skills or hobbies you’d be willing to demonstrate as a small group activity.
Please complete this form and return with your $30 membership check made payable to: Barrington Newcomers &
Neighbors
Mail to: Janet Mahanay, 23366 N Chesapeake Drive, Barrington, IL 60010
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