Garfield Ridge Neighborhood Watch
Membership Application
P.O. Box 389039
Chicago, IL 60638-2517
*** Please complete the information below, print, and submit with proper supporting
documentation requested to GRNW, P.O. Box 388820, Chicago, IL 60638 ***
Name _______________________________date_______________
(please print legibly)
Male ( ) Female ( ) Age___________Birthdate__________________
Address_______________________________________________
Home Phone ________________ Cell phone__________________
Spouse’s name (if applicable)______________________________________
Illinois Driver’s License Number_________________________________
(attach copy of DL or State ID)
Auto Insurance Provider________________________________________
(attach copy of card to verify proof of insurance)
Vehicle Year, Make and Model___________________________________
Vehicle color and plate number__________________________________
Driving Restrictions, if any______________________________________
Occupation____________________________________________
Emergency Contact Information
In case of Emergency, please contact:
Name ______________________________________________________
Relationship____________________________________________
Contact Number_______________________________________________
Any medical conditions that organization should be aware of:
___________________________________________________________
Member’s signature________________________________ date_________________
Date of interview___________________________________
Probationary period from_________ to ________________
Comments____________________________________________
_____________________________________________________
_____________________________________________________
Shirt size (polo style) __________________
Email address________________________________________________
All applicants are subject to a background check conducted by the Chicago Police Department as well as an interview
by the board members of the GRNW.
Upon membership acceptance, a one-time $20 fee will be required to cover the cost of your shirt, badge and lanyard.
Membership Application
P.O. Box 389039
Chicago, IL 60638-2517
*** Please complete the information below, print, and submit with proper supporting
documentation requested to GRNW, P.O. Box 388820, Chicago, IL 60638 ***
Name _______________________________date_______________
(please print legibly)
Male ( ) Female ( ) Age___________Birthdate__________________
Address_______________________________________________
Home Phone ________________ Cell phone__________________
Spouse’s name (if applicable)______________________________________
Illinois Driver’s License Number_________________________________
(attach copy of DL or State ID)
Auto Insurance Provider________________________________________
(attach copy of card to verify proof of insurance)
Vehicle Year, Make and Model___________________________________
Vehicle color and plate number__________________________________
Driving Restrictions, if any______________________________________
Occupation____________________________________________
Emergency Contact Information
In case of Emergency, please contact:
Name ______________________________________________________
Relationship____________________________________________
Contact Number_______________________________________________
Any medical conditions that organization should be aware of:
___________________________________________________________
Member’s signature________________________________ date_________________
Date of interview___________________________________
Probationary period from_________ to ________________
Comments____________________________________________
_____________________________________________________
_____________________________________________________
Shirt size (polo style) __________________
Email address________________________________________________
All applicants are subject to a background check conducted by the Chicago Police Department as well as an interview
by the board members of the GRNW.
Upon membership acceptance, a one-time $20 fee will be required to cover the cost of your shirt, badge and lanyard.
