Bellevue Civic Association
	Membership Form
	Please print, complete, and return to:
	Bellevue Civic Association
	P.O. Box 15623
	Richmond, VA 23227-5623
Name		__________________________________
Street Address		__________________________________
		__________________________________
ZIP		_______
Phone		___________
Family Size		___
Dues are $15		per family per calendar year
Amount enclosed		______
Would you like to serve on a Civic Association Committee?  (Please check)
___		Membership
___		Fundraising/Finance
___		Newsletter
___		Programs
___		Neighborhood Watch
___		Education
___		Neighborhood Preservation
___		Garden Walk
___		Neighborhood Clean Up
Suggestions/comments? __________________________________________