Mobile Home Park Owners-Developers Association 
 Wayne County, NC
 Kenny Fallin, President
updated 19 June 2017

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MEMBERSHIP APPLICATION
Mobile Home Park Owners - Developers Association

To join this Association, you may print this application and send it with your annual dues to: Attn: Pattie Daly 363 St. John Church Rd. Goldsboro, NC 27534.

Name of Applicant: ______________________________________________________

Full Mailing Address:_____________________________________________________

Phone Number: (Home)  ______________________     (Cell)  _____________________

E-mail Address: _______________________________________________________    

Are you a Mobile Home Park (MHP) Owner? _____   How many parks do you own?  _____

Are you a MHP Manager? _____     Number of parks managed?  _____

Name of Mobile Home Park(s) that you own or manage and their location: 
(Use back side of application if you need more space).
                       NAME​ & LOCATION                                                            SIZE
                                                                                                                (Example: 10 acres with 15 lots)
a.________________________________              ______________________________

b.________________________________              ______________________________

c.________________________________              ______________________________


Do you have someone else that operates/manages your park and will represent you on this Association?  If yes, please provide their name_________________________________

What do you hope to see achieved by this Association?___________________________

_____________________________________________________________________

Does your park(s) have to operate under city or county rules or both?

_____________________________________________________________________

Are you willing to be an ACTIVE member of this association? 
(i.e. attend meetings, work on committees, etc.)

_____________________________________________________________________

Do you currently hold a position in the Association? If not, what committee would you like to work on? 

_____________________________________________________________________

If you are not a park owner, what is your profession and affiliation with this Association? 

_____________________________________________________________________


I agree to abide by the Association By-laws and to pay annual dues of $ _____

Applicants Signature: ___________________________________________________ 

                          Date: _____________________________________


_________________________________________________________________________________________________________________________________
This section is reserved for the Membership Committee & Association Officers. 

Based on By-Laws and information provided in the application what type member is the applicant?

1. Member:  ______ (park owner or manager)

2. Affiliate Member:  ______ (like business interests, etc.)

3. Public Service Members:  _______ (public utilities & services, etc.) (non-voting)

4. Honorary Member:  _______  (notable service, etc.) (non-voting)

Recommended to serve on the ___________________________________Committee.

Received Annual Dues of $ ____________   Date Received: _________________

Approved by Membership Committee: _________________  Approval Date: ________________ 

Membership Number: _________________________

Note: membership number will start with a 1,2,3, or 4 based on type of member shown above. After that, the second number will be 001, 002, etc.
Last revision of application form: 10/08/2013