Welcome to our online Membership Registration submission
Begin Registration
 
Membership Type: *


 
Membership Level: *


 
First Name: *

First name of the individual applying for membership (if family, other names will go below)
 
Last Name: *

Last name of individual applying for membership
 
Spouse:

 
Minor Children:

(Anyone 18 and over, unless permanently disabled, needs to be a separate membership)
(Separate children's names with a comma)
 
Address: *

 
City: *

 
State: *

 
Zip Code: *

 
Phone Number: *

 
Do you wish to include a donation as part of your application? Include amount below if so desired.

 
Would you like to receive the newsletter by email? *

     
 
Would you like to receive information on work parties and participate in them? *

     
 
Would you be willing to make phone calls and write letters on behalf of the village? *

     
 
Would you like to become a docent? *

     
 
May we list your contact information in a membership directory? *

     
 
Interested in being a House Parent? *

(Opportunity becomes an option after 1 year of membership)
     
 
Interested in becoming an Assistant House Parent? *

(Assistant House Parents help the main House Parent with the cabin and can represent the house if the main House Parent cannot attend)
     
 
Would you like to help with any of the following:


 
Membership Description: 
1) You will receive a newsletter at least every other month
2) Membership meetings are held once a month. Dates to be published on the website and Facebook
3) House Parent interest does not guarantee a cabin and members can only be considered after one year of membership.

 
Submit this form and mail payment to: 
Caesar's Creek Pioneer Village
P.O. Box 652
Waynesville, Ohio 45068

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