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2. Last Name*
3. First Name*
5. Street Address
6. City/Town*
8. State*
9. Zip Code*
10. Mailing Address (If Different)
12. Email Address*
13. Phone Number*
15. Are you applying as a citizen member or representing an organization or business?*
    -- Select One --Citizen MemberOrganization/Business
16. If representing an organization, please provide the Name
18. Please share why you are interested in being a member of the South Kingstown USA 250th (Semi-quincentennial) Committee and how you envision contributing to this effort.*
20. Are you available for evening meetings on a quarterly basis from spring 2025 through summer of 2026?*
    -- Select One --YesNo
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22. 1. Receive an email copy of this form.
23. Email address

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24. Submit

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