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ELCOME  T THE  BERRYESSA CITIZENS  ADVISORY  COUNCIL 
    

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 " Community Leadership and Empowerment "

Membership Application

Please print out the following form and 
Mail it along with your dues to:

The Berryessa Citizen's Advisory Council
Treasurer Dale Osborn
2706 Middleborough Circle
San Jose, CA 95132

Please check any or all of the special interest boxes, 
if you would like to receive additional mailings if the situation arises.

Yes! I would like to join the Berryessa Citizens Advisory Council.

I am interested in The Berryessa Community and in neighborhood enhancement, preservation, or land use issues such as planning, traffic, safety, open space, 
park, or recreation.

[ ] household ($10); [ ] Business / Association ($25); additional donations: ______________ ( Thank you )

name: _________________________________________________________________

street: _____________________________________________________ apt._______

city / state / zip: _______________________________________________________

day phone: (_______)_______________________ evening: (_______)____________

[ ] Schools; [ ] art; [ ] bike routes; [ ] emergency preparedness; [ ] graffiti abatement;

[ ] parks & recreation; [ ] traffic/parking; [ ] tree plantings; [ ] zoning/land-use.