New Member Application or Membership Directory Update
Annual membership dues are $30.
Be sure to indicate whether or not you would like your contact information published in our Membership Directory.
Please provide us with the information you would like to have printed in the annual Membership Directory. (Please include your telephone number in case we need to reach you for further information.)
Type of Request
Update Membership Directory Information Remove Me From the Directory New Application for Membership
Name *
Street Address
City
Work Phone
Email Address *
Magisterial District
Brentsville City of Manassas City of Manassas Park Coles Dumfries Gainesville Neabsco Occoquan Woodbridge Select
Referred By
* Name and e-mail address are required
Community Affiliations (civic, charitable, religious, community, political, professional groups, etc.)
Offices Held
Copyright © 2004-2010 • Prince William Committee of 100 • P.O. Box 1415 • Manassas, VA 20108
