Name (required)

No. And Street

Phone Number

Email (required)*

Volunteer Opportunities (optional)
Check all those you are interested in:

Beautification
Emergency Preparedness
KPP Cleanup
Neighborhood Watch
July 4th Picnic/Parade
Children Holiday Party
Octoberfest
National Night out

In case of an emergency disaster would you need special help in relocating to a safe location?
N/AYesNo

In case of an emergency disaster would you be willing to help an elderly/physically challenged resident?
N/AYesNo

Are you registered with the Fairfax County OEM Functional Needs Registry
N/AYesNo

Membership Due
—Please choose an option—Regular Membership -$30Senior Membership - $25Optional contribution for KP beautification/upkeep

*By providing my email address, I (we) agree that notice of meetings and other community information may be provided to us via the above e-mail.

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