Membership Application

Please indicate your membership eligibility:*
- Employee of City of Lewiston*
- Employee of City of Auburn*
- Family member / domestic partner / household member is a member/eligible member
- Already a member
*Includes all City employees including City Hall, Police, Fire, Public Works, Libraries, School Department, Housing Authorities, etc.
Membership Type:*
- Individual
- Joint
- Organization/Business
- Minor
Member
Name*
First Middle Last Suffix (if any)
Physical Address*
Address Line 1 Address Line 2 City State ZIP Code
Mailing Address (if different from physical address)
Address Line 1 Address Line 2 City State ZIP Code
Phone*
Email*
Social Security Number*
Date of Birth*
MM slash DD slash YYYY
Mother's Maiden Name*
State ID or Driver's License Number*
Membership for Minor
Name*
First Middle Last Suffix (if any)
Physical Address*
Address Line 1 Address Line 2 City State ZIP Code
Mailing Address (if different from physical address)
Address Line 1 Address Line 2 City State ZIP Code
Phone*
Date of Birth*
MM slash DD slash YYYY
Social Security Number*
Joint Member
Name
First Middle Last Suffix (if any)
Physical Address*
Address Line 1 Address Line 2 City State ZIP Code
Mailing Address (if different from physical address)
Address Line 1 Address Line 2 City State ZIP Code
Mailing Address (if different from physical address)
Address Line 1 Address Line 2 City State ZIP Code
Phone*
Email*
Date of Birth*
MM slash DD slash YYYY
Social Security Number*
Mother's Maiden Name*
State ID or Driver's License Number*
Organization/Business
Business / Organization Name
EIN or SSN
Type*
- d/b/a or Sole Proprietor
- Limited Liability Company (LLC)
- Corporation
- Organized Association (has a Charter and Officers)
- Informal Organization (e.g. Scouts, Alumni groups)
- Other
Primary Contact*
First Middle Last Suffix (if any)
Primary Contact Role
- Owner / Sole Proprietor
- Authorized Signer
- Officer
- Other
Secondary Contact (if applicable)
First Middle Last Suffix (if any)
Physical Address
Address Line 1 Address Line 2 City State ZIP Code
Mailing Address (if different from physical address)
Address Line 1 Address Line 2 City State ZIP Code
Primary Contact Email Address*
Enter Email Confirm Email
Phone*
Phone
This field is for validation purposes and should be left unchanged.

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Membership Application

Membership Application

Member

Membership for Minor

Joint Member

Organization/Business