Join the Chic’s Beach Civic League

Name*
First Last
Address*
Street Address City State Zip
Email*
Mobile Phone
Home Phone
Type of Membership*
These are Yearly Fees
Additional Household Name
Please enter the other adult member in your household
First Last
Mobile Phone of Additional Adult
Enter the Mobile Phone of the additional adult
Would you like to make an additional donation?
- YES
Donation Amount
Mailing Fee
Price: $10.00
TOTAL AMOUNT TO PAY
How would you like to pay?
- CHECK OR MONEY ORDER
- CREDIT CARD
If paying by CHECK, please send money to:
(this address will be included in the email you will receive)

Chesapeake Beach Civic League
P.O. Box 5118
Virginia Beach, VA 23471
Secure Credit Card Payment

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
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Chic's Beach Civic League © 2010-2020

www.cxbcivicleague.com

P.O. Box 5118
Virginia Beach, VA 23471

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