(New) Member Inforrmation Form

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Blue Rock Heights
(New) Members Form
for new residents/members of Blue Rock Heights Association
One membership per household
Blue Rock Heights (BRH) or Blue Rock Landing (BRL)
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Residents who need to modify existing information please contact
Dennis Mascio

This form is Informational only - you must pay your dues to become a member

New owner (BRHA residents) please complete this online form
We will respond to you as to whether you inherited a membership from the prior owner
If there is not an inherited membership you will need to submit the $300 to be a member
When the Treasurer (Terry Mallett) gets the $300, you will be added to the directory.

***** New members joining the association should send their dues ($300/yr, checks made out to BRHA) to: *****
BRHA, PO Box 791, S Yarmouth MA 02664
or
Drop off @ Terry Mallett, 16 Legend Dr.
If the address on your check is not your local (Blue Rock) address, please indicate the local address on the memo line
You are NOT a member until this form, or a hard copy of this form, is submitted and your dues are paid.

* Indicates required field

Application for: *

Blue Rock Heights Resident - Membership Blue Rock Landing Resident - BRH Associate Membership Blue Rock Heights Resident - Info Only

Do you live in BRH or BRL?
Street Map of Blue Rock Height
and the Landing
brh-brl_str_map.pdf

Primary Person's Name *

First

Last

Name Person 2 *

First

Last

Primary Person's Email *

Email Person 2 *

All correspondence and notices are done via E-Mail - it is important that at-least one e-mail is included!

Primary Person's Cell Phone Number *

Cell Phone Number Person 2 *

Land Line Phone *

Blue Rock Address *

Line 1

Line 2

City

State

Zip Code

Country

Off Cape Address *