Name:_________________________________________ Phone:_____________________________
Address:_______________________________________ Email:______________________________
Do you participate in Neighborhood Watch? ___yes ___no
Name of Neighborhood Watch Captain_______________________________
I am interested in serving on the following committees:
Voting members must be at least 18 years of age and reside within the Sam Hughes Neighborhood which is bounded by Broadway, Speedway, Campbell & Country Club.
Please enclose a check for $20.00 payable to: SHNA, c/o Leon Bear, Treas., POB 42931, Tucson AZ 85733