Member Signup Form

United Neighborhoods of Santa Clara County
Linking and Developing Healthy Neighborhoods

Member Signup Form

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Required info:

* Email address:

* Name:

* Password:

* Repeat:

Personal Information:

Receive Newsletters via email? Yes No

Neighborhood Association Information:

Neighborhood Association Name:

UNSCC Member? Yes No

UNSCC Member Type?

City:

Neighborhood Boundaries:

North:

South:

East:

West:

Additional Neighborhood Association Information:

Website URL:

Year Established:

Number of Households:

Number of Members:

Organization Mission:

Recent Projects:

Neighborhood Contacts - UNSCC Representative, Neighborhood Association President, Treasure, and Planning & Land Use Chair (PLUC):

Include Contact Info in UNSCC Directory: Yes No

UNSCC Rep Name:

UNSCC Rep Phone:

UNSCC Rep Address:

UNSCC Rep City, State, Zip:

UNSCC Rep Email:

President Name:

President Phone:

President Address:

President City, State, Zip:

President Email:

Treasurer Name:

Treasurer Phone:

Treasurer Address:

Treasurer City, State, Zip:

Treasurer Email:

Planning & Landuse Chair (PLUC) Name:

PLUC Phone:

PLUC Address:

PLUC City, State, Zip:

PLUC Email:

Government Representatives:

City Council District:

County Supervisor District:

State Assembly District:

State Senate District:

US Congressional District: