Please Print:

Name: _____________________________________

Address: ___________________________________

___________________________________________

City, State, ZIP: ____________________________

Phone: ____________________________________

Email: _____________________________________

** Please fill out questionnaire at the bottom of this page**

_____ Check/Money Order enclosed

(payable to: Friends of Pomham Rocks Lighthouse)

Mail application to:

Friends of Pomham Rocks Lighthouse

P.O. Box 15121

East Providence, RI 02915

For more information on our organization, contact us at: pomhamrockslighthouse@yahoo.com

Questionnaire

1. Preferred way of communicating with you about regular meetings, upcoming events, etc. ________ Email ________ U.S. Mail Service

2. Your area(s) of interest in our organization

_____ Fundraising / Grant Writing

_____ Committee Work

_____ Historical Research

_____ Leadership Role

_____ Publicity

_____ Membership

_____ Web Site Design

_____ Provide Services / Products (please explain) ______________

_____ Other (please explain) _________________

3. Do you have any expertise / knowledge that may assist the organization? _____ No _____ Yes (please explain)

____________________________________________________

 

____________________________________________________

 

____________________________________________________

4. Have you ever participated in the restoration activities of a lighthouse? _____ No _____ Yes (please explain)

    

    ____________________________________________________

    

   ____________________________________________________

    

   ____________________________________________________

5. How did you hear about the Pomham Rocks Lighthouse restoration?

_____ Friends

_____ Magazine

_____ Business Colleague

_____ Newspaper

_____ Member of another organization

_____ TV

_____ Other: ________________________________________________