Gerritsen Beach Cares, Inc.

GBC Hotline: 718-648-3745

Membership and/or Donation Application

April 1, 2003 through March 31, 2004

Membership rates: $10 per-person or $25 family of 3 or more per household within the boundaries of GBC

Donations: All donation and accepted and appreciated. (If you are not a resident or a merchant within the

boundaries of GBC. You will be known as a friend of GBC)

Please make checks payable to: “Gerritsen Beach Cares, Inc.”

Please mail to our: Membership Administrator Jane DeWitt at 2 Cyrus Avenue, Brooklyn, NY 11229 or
you can drop it off at Fair Deal Video 2722 Gerritsen Avenue, Brooklyn, NY 11229

First & Last Name(s): ________________________________________________________________

Address: ___________________________________________________________Apt: ___________

Home Phone: _____________________________ Work or Cell Phone: ________________________

E-mail address: ____________________________________________

Amount Paid: ____________Cash or Check Number ______________

Additional donation (circle one): $25 $50 $100 $250 Other $________ Thanks!

Please check your membership category:

____ Resident, Family or Merchant of GBC _____ Former Resident of GB or Friend of GBC (Donation)

______ Yes, I would like to help out with a GB Cares project or event. Call me to discuss if further.

Signature: _____________________________________ Date: ____________________________

Your support or involvement is always needed and appreciated. Thank you!!!

Comments:_________________________________________________________________

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