Name: ____________________________________________________________

Street Address: ____________________________________________________

Virginia Beach, VA 23452

Home Phone: _______________________ Work Phone: _____________________

_____ Please check here if you would like to receive emails related to the civic league and other
ongoing events in Thalia. Your email will only be used to send out information related to civic league
business and not provided to anyone for any other purpose.

E-mail Address: ______________________________________________________

PLEASE CHECK  as applicable:            

· ____       Sign my household up as a member of the Thalia Neighborhood Watch Program.

· ____       I need more information on the Neighborhood Watch Program.

I hereby apply for membership in the Thalia Civic League, Inc. and Thalia Neighborhood Watch

Annual membership dues are $10.

Signature ______________________________________


Please submit this completed form along with a check or money order (made payable to the Thalia
Civic League, Inc.) to the following address:

Thalia Civic League, Inc.
c/o Mike Dougherty, Treasurer
631 Lynn Shores Drive
Virginia Beach, VA 23452

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