Membership Form
Name
Email
Property Address
Mailing Address (if different)
Home Phone
Alt Phone
Resident 2 Name
Resident 2 Email
Resident 2 Alt phone
Membership Level (Check One)	Select $250 Live Oak Super Neighbor $175 Red Oak Patron $100 White Oak Supporter
Southampton Newsletter Delivery Preferences	Select email regular mail
Request SHCC stickers to identify your vehicle to Southampton Patrol	Yes No
How Many Stickers do you Want?
Comments and Suggestions
Questions? Call 713-523-SHCC (7422) or email info@southampton@southamptoncivicclub.org
If you pay your dues by check make out check to S.H.C.C.
If you pay your dues online, after submitting this form go to Home page and select PayPal Dues Pay