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                            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.
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