NAME:

(Couples please list both names)

ADDRESS:

TOWN: Select one Acton Boxborough Other   if other

EMAIL ADDRESS:

HOME PHONE:    WORK PHONE: 

How did you hear about AB Newcomers & Neighbors?

Children's names and birth dates:

Child 1 name: DOB:

Child 2 name: DOB:

Child 3 name: DOB:

Child 4 name: DOB:

Where was your last residence?:

Do you have a teenager interested in baby sitting? YES NO

WHICH ADDITIONAL ACTIVITIES ARE YOU INTERESTED IN? (Please check all that apply).

Book Group 

Neighbor to Neighbor

Dinner Group

Ladies Night Out

Lunch Bunch

Men's Night Out

Help Special Events Team coordinate an event

Wine Tasting

Day Trippin'

Would you be interested in starting a new group? NO YES

If YES, what kind of group?

Although Acton/Boxborough Newcomers and Neighbors has not been a party to a lawsuit or legal action, the Board would like to be proactive in this regard. The Board has adopted the following language that must be agreed to by every member.

The undersigned, representing him or herself and any family members, hereby agrees that they will not hold either A/B Newcomers & Neighbors and/or a fellow member of the A/B Newcomers & Neighbors club, liable for damages that may result from an action or inaction by a fellow member from hosting or attending an A/B Newcomers & Neighbors Club event as sanctioned by the A/B Newcomers & Neighbors Club. Also, the undersigned understands that all family members may be photographed, videotaped, or digitally recorded and hereby waives any objection, condition, limit or other rights to same. The undersigned authorizes A/B Newcomers & Neighbors club to use any such photograph, videotape or other recording for any purpose and to license others to use it. The undersigned hereby indemnifies and holds A/B Newcomers & Neighbors Club harmless for any such use or licensed use, and for any unlicensed use also.

 I agree to the above   Please select YES NO           Date:

NOTE: A/B Newcomers & Neighbors is open to all residents of Acton and Boxborough. We reserve the right to review all applications for membership.